Development of the physician–pharmacist partnership intervention to deprescribe medications (P3iD) and its feasibility in clinical practice

BACKGROUND: Polypharmacy and the use of potentially inappropriate medications (PIMs) are major concerns in managing older adults with multiple chronic conditions, as they can increase the risk of adverse drug reactions. However, data on deprescribing interventions for older persons in lower- to middle-income countries (LMIC) remains limited. PURPOSE: To develop and evaluate the feasibility of the Physician-Pharmacist Partnership Intervention to Deprescribe Medications (P3iD) among ambulatory older persons. METHODOLOGY/APPROACH: The P3iD, a health workforce model intervention for deprescribing medications among older adults, was developed based on findings from previous literature and a qualitative study. This intervention consists of five steps: (1) potentially inappropriate medication (PIM) identification, (2) decisions on prioritization of cessation, (3) medication withdrawal, (4) monitoring and support, and (5) documentation. A feasibility study was conducted in March 2022 at a tertiary primary care clinic at a teaching hospital, which offers general outpatient services, including preventive care, routine health check-ups, and chronic disease management. Participants aged 65 years or older with multiple chronic diseases, prescribed five or more medications with at least one PIM (according to Beer's Criteria 2019), were recruited. Physician partners were drawn from their treating physicians, who comprised family medicine trainees. The intervention was conducted by a pharmacist in collaboration with the patient's doctor. RESULTS: Twenty participants and 14 doctors were recruited. Participants consumed a total of 167 medications, from which 36 (22%) PIMs were identified. Deprescribing was performed on 14/20 (70%) older patients. The number of PIMs accepted for deprescribing was 19/36 (52.7%). CONCLUSION AND PRACTICE IMPLICATIONS: Recruiting older adult participants and conducting the P3iD in a tertiary primary care clinic was feasible. Incorporating deprescribing into routine practice through periodic medication reviews provides a structured, safer, and more effective approach to managing polypharmacy and improving patient outcomes, subsequently optimizing health management and strengthening health care systems.