Discontinuation of medication in older patients with polypharmacy in primary care: development of a complex intervention

• Applicants: Professor Dr. Norbert J. Donner-Banzhoff; Professorin Dr. Ulrike Junius-Walker
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Biogerontology and Geriatric Medicine ; Pharmacology
• Term: from 2016 to 2020
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 282998937

• Final Report Year: 2020

Final Report Abstract

The prevalence of polypharmacy is rising(1) despite related risks such as side effects, drug interactions or adherence problems(2). Yet, no consented deprescribing tool for primary healthcare-practitioners exists in the German setting. The project “Deprescribing medications among elderly patients with polypharmacy in primary care: development of a complex intervention” aimed to explore current deprescribing practice in primary care and develop a generic deprescribing tool. A feasibility test lastly aimed to evaluate usability aspects of the developed deprescribing tool. Over the 36-months-project course, a systematic review on generic deprescribing instruments, qualitative interviews with patients, and focus-group discussions with general practitioners, specialist practitioners as well as pharmacists were conducted. The knowledge of this explorative stage informed the formulation of six core criteria which formed basis of a patient-centered deprescribing algorithm. The algorithm aims at identifying unnecessary medication and is accompanied by a shared decision-making component supporting practitioner-patient communication, as well as an individualized implementation component to instruct and monitor deprescribing attempts. Together, these components form the arriba® MediQuit software which assists generic deprescribing of unnecessary medication at a primary-care setting. arriba® MediQuit is guiding sustained deprescribing while promoting patient empowerment in medication optimization. arriba® MediQuit was validated and optimized in an interdisciplinary expert panel before being evaluated on feasibility and utility aspects in a feasibility test. During the latter, ten general practitioners enrolled 41 elderly patients with polypharmacy for medication counselling using arriba® MediQuit software. 70% of the patients reported deprescribing of at least one medication under the consultation and 57% reported sustained medication withdrawal 4 weeks after the consultation. The developed deprescribing tool arriba® MediQuit proved as an applicable instrument for guided medication deprescribing in a primary-care setting. Patient satisfaction with the software-assisted medication consultation was high. The participating practitioners rated the patient orientation components as particularly helpful. Their detailed assessments of the MediQuit components indicated some areas of improvement. This led to an ongoing upgrade of the MediQuit deprescribing tool. the next step is to evaluate the effectiveness of the MediQuit software in a cRCT.

Publications

• 51. Kongress für Allgemeinmedizin und Familienmedizin - 21.-23.9.2017. Einfussfaktoren auf Medikamenten-Absetzentscheidungen: die Perspektive der Patienten. I-VT1 /3
  Tanja Schleef, Olaf Krause, Navina Gerlach, Matthias Michiels-Corsten, Annika Viniol, Norbert Donner-Banzhof, Ulrike Junius-Walker
  
• 51. Kongress für Allgemeinmedizin und Familienmedizin - 21.-23.9.2017. Exploration zu Absetzstrategien bei Patienten mit Polypharmazie: Eine interdisziplinäre Perspektive (#151) I-VT1 /2
  N. Gerlach, M. Michiels-Corsten, T. Schleef, Dr. O. Krause, Prof. Dr. N. Donner- Banzhoff, Dr. U. Junius-Walker, Dr. A. Viniol
  
• 52. Kongress für Allgemeinmedizin und Familienmedizin - 13.-15.9.2018. Absetzhilfen bei Polypharmazie: ein systematisches Review aus dem MediQuit-Projekt (#326) III-VT7 - Evidenzbasierte Versorgung chronisch Kranker III
  Matthias Michiels-Corsten, Navina Gerlach, Tanja Schleef, Norbert Donner-Banzhoff, Ulrike Junius-Walker, Annika Viniol
  
• 52. Kongress für Allgemeinmedizin und Familienmedizin - 13.-15.9.2018. Entwicklung der MediQuit-Absetzhilfe bei Polypharmazie-Ergebnisse eines Panel-Tests (#274) II-VT4 | Evidenzbasierte Versorgung chronisch Kranker II
  N. Gerlach, M. Michiels-Corsten, A. Viniol, U. Junius-Walker, T. Schleef, N. Donner- Banzhoff
  
• 53. Kongress für Allgemeinmedizin und Familienmedizin - 12.-14.9.2019: Viniol arriba-MediQuit: Die Absetzhilfe bei Polypharmazie im Praxistest (#99) V33-02 – Quartäre Prävention
  M. Michiels-Corsten, N. Gerlach, T. Schleef, U. Junius-Walker, N. Donner-Banzhoff, A. Viniol
  
• Generic instruments for drug discontinuation in primary care: A systematic review. Br J Clin Pharmacol. 2020;86:1251–66
  Michiels-Corsten M, Gerlach N, Schleef T, Junius-Walker U, Donner-Banzhoff N, Viniol A
  (See online at https://doi.org/10.1111/bcp.14287)
• Professional Roles of General Practitioners, Community Pharmacists and Specialist Providers in Collaborative Medication Deprescribing - A Qualitative Study. BMC Family Practice
  Gerlach N., Michiels-Corsten M., Viniol A., Schleef T., Junius-Walker U, Olaf Krause, Donner-Banzhoff N.
  (See online at https://doi.org/10.1186/s12875-020-01255-1)