Development of a shared decision-making intervention to improve drug safety and to reduce polypharmacy in frail elderly patients living at home

E Drewelow; M Ritzke; A Altiner; A Icks; J Montalbo; V Kalitzkus; S Löscher; Y Pashutina; S Fleischer; J Abraham; P Thürmann; N K Mann; B Wiese; S Wilm; A Wollny; G Feldmeier; T Buuck; A Mortsiefer; COFRAIL study group

doi:10.1016/j.pecinn.2022.100032

Development of a shared decision-making intervention to improve drug safety and to reduce polypharmacy in frail elderly patients living at home

PEC Innov. 2022 Mar 24:1:100032. doi: 10.1016/j.pecinn.2022.100032. eCollection 2022 Dec.

Authors

E Drewelow¹, M Ritzke¹, A Altiner¹, A Icks², J Montalbo², V Kalitzkus³, S Löscher³, Y Pashutina³, S Fleischer⁴, J Abraham⁴, P Thürmann⁵, N K Mann⁵, B Wiese⁶, S Wilm³, A Wollny¹, G Feldmeier¹, T Buuck¹, A Mortsiefer⁷; COFRAIL study group

Affiliations

¹ Institute of General Practice, University Medical Center Rostock, Doberaner Straße 142, 18057 Rostock, Germany.
² Institute for Health Services and Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
³ Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
⁴ Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle, Germany.
⁵ Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany.
⁶ WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
⁷ Institute of General Practice and Primary Care, Faculty of Health, Department of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.

Abstract

Objectives: For patients with geriatric frailty, reducing inappropriate medication is an important goal to improve patient safety in primary care. GP-side barriers include knowledge gaps, legal concerns, and lack of communication between the actors involved. The aim was to develop a multi-faceted intervention to facilitate deprescribing and shared prioritisation among frail elderlies with polypharmacy living at home.

Methods: Mixed methods study including: 1) scoping review on family conferences, expert panels; 2) group discussions with GPs, mapping of needs and challenges in Primary Care; 3) workshops and expert interviews with GPs, patient advocates, researchers as a basis for a theoretical intervention model; 4) piloting.

Results: A major challenge for GPs is to conduct a productive discussion with patients and family cares on deprescribing and drug safety. A guideline for a structured family conference with a medication check and geriatric assessment was developed and proved to be feasible in the pilot study.

Conclusion: The intervention developed to facilitate deprescribing and shared prioritisation of drug therapy based on family conferences seems suitable to be tested in a subsequent cRCT.

Innovation: Adapting family conferences to primary care for frail patients with polypharmacy.

Keywords: Deprescribing; Family Conference; Frailty; Polypharmacy; Primary Care.