Polypharmacy in Multimorbid Older Adults: Evaluating the efficacy of a structured medication review protocol in a family practice setting

Background: Polypharmacy is an important risk factor for adverse effects in older people who have more than one diagnosis. Scheduled medication reviews (MRs) have been recommended, but there isn't an abundance of assurance that they operate in public general care.

Objective: The goal is to figure out how a structured MR protocol affects consequences relating to polypharmacy in a family health service.

Methods: An intervention Cohort (n=248; patients aged 65 or older with not less than two chronic medical conditions and at a minimum five medications) and a Historical Control Cohort (n=240; similar patients from January to June 2023) were contrasted in a retrospective cohort study. The Intervention Cohort received the protocol between August 2023 and January 2024. At 6 months, the primary findings were variations in the mean number of medications and the number of Potentially Inappropriate Medications (PIMs, Beers Criteria). Hospitalisations and admissions to the emergency room (ED) were secondary outcomes.

Results: The total quantity of medicines decreased much more in the group participating in the intervention (mean change: -1.4) than in the control group (-0.3), with an adjusted mean difference of -1.1 medications (95% CI: -1.4 to -0.8; p<0.001). The group that experienced the intervention had 67% fewer odds of having a PIM at the follow-up (aOR=0.33, 95% CI: 0.22-0.49; p<0.001). 42% (IRR=0.58, p=0.003) fewer people spent time at the hospital, and 31% (IRR=0.69, p=0.009) fewer people proceeded to the emergency room. 

Conclusion: A structured MR protocol in family practice effectively minimises the number of medications elderly patients demand, the number of occasions that they are prescribed the wrong ones, and their emergency room encounters.