Implementing a medication review and deprescribing intervention for older people living with frailty and polypharmacy in general practice: a feasibility study

BACKGROUND: Polypharmacy in older adults with frailty increases risks of adverse outcomes. Evidence supports proactive structured medication reviews (SMRs) for medicines optimisation, including deprescribing; however, challenges exist in general practice. AIM: To test the implementation of a co-designed multidisciplinary SMR intervention (MODIFY) for this high-risk group. DESIGN & SETTING: A non-randomised pre-post feasibility study was conducted across five general practices in England. The multidisciplinary intervention comprised five components including patient and healthcare professional (HCP) preparation. METHOD: Patients aged ≥75 years with moderate-to-severe frailty (electronic Frailty Index [eFI] >0.25) and ≥5 medications were identified and invited to participate. Primary outcomes were recruitment, retention, and completion of outcome measures. Secondary outcomes included medication-related outcomes, healthcare utilisation, adverse drug reactions, and acceptability to patients and HCPs based on qualitative interviews. RESULTS: Of 479 patients invited, 48 were recruited (10% rate); 47 received the intervention, 43 completed 3-month follow-up (91% retention). Medication changes occurred in 87% of participants; 72% had at least one medication stopped and 26% had a dose reduced. The mean number of medications decreased slightly by 0.27 (standard deviation [SD]: 1.44) without significant change in clinical and patient-reported outcomes (including function, frailty status, treatment burden) and no reported adverse events. Qualitative interviews with 10 patients, one carer, and eight HCPs, indicated high acceptability and perceived value, and suggested improvements. Economic data were well completed. SMRs cost £28.50 per patient. Participants' reported quality of life improved slightly over 3 months. CONCLUSION: The MODIFY intervention is feasible and acceptable for deprescribing in primary care. The study findings support progression to a definitive trial.