Geriatrician assessment could help GPs with older people’s medicines optimisation
A study published in the BMJ Open has shown that a thorough medication review by a secondary care geriatrician can help drastically reduce polypharmacy in older people.
A study has found that involving secondary care geriatricians in general practice could help support GPs in optimising older patients’ medications.
The study, published in the BMJ Open showed that geriatricians were able to recommend medication changes in 91% of patients who were taking at least eight medications.
The trial was carried out at seven GP practices in the Stoke-on-Trent area and involved 186 GP-selected patients who were on at least eight medications per day and aged 65 years and over. Each patient was invited to a comprehensive assessment with a geriatrician, involving full history and clinical examination, as well as assessments of balance, mobility and mental function who then made recommendations for further assessments, investigations or medication changes.
Overall, geriatricians made 687 recommendations regarding medication for 169 patients. The most common recommendation was to stop medications (34%), with 71% of patients were advised to stop at least one medication. Reducing the dosage (24%) was also frequently recommended. Starting a different medication was recommended for 44% of patients (constituting 18% of recommendations) and changing to an alternative medication was recommended for 35% of patients (13% of recommendations).
After six months, adherence to the recommendations was 72%, and 65% at 12 months, which the researchers say indicates good acceptability by GPs and patients.
The team, led by Ruth Chambers of Stoke-on-Trent Clinical Commissioning Group, said the findings indicated the potential of the strategy to tackle inappropriate prescribing and polypharmacy in primary care.
“Given that about 90% of healthcare contacts take place in primary care, there is much to gain through interventions to address potentially harmful polypharmacy in community settings,” they wrote. “To this end, pharmacists can also make a valuable contribution, as it has been shown that they can result in more appropriate prescribing, drug cost reductions and reduced healthcare services usage.”
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204577
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