Artikel
Development of a deprescribing guideline for the COFRAIL study: Family conferences and shared prioritisation to improve patient safety in the frail elderly. A cluster randomised intervention trial in primary care
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Autoren
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Nina-Kristin Mann
- Lehrstuhl für Klinische Pharmakologie, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
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Sven Schmiedl
- Lehrstuhl für Klinische Pharmakologie, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
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Attila Altiner
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, Germany
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Andrea Icks
- Institut für Versorgungsforschung und Gesundheitsökonomie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
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Achim Mortsiefer
- Institut für Allgemeinmedizin (ifam), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Birgitt Wiese
- Medizinische Statistik und IT-Infrastruktur, Institut für Allgemeinmedizin; Medizinische Hochschule Hannover, Hannover, Germany
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Stefan Wilm
- Institut für Allgemeinmedizin (ifam), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Petra A. Thürmann
- Lehrstuhl für Klinische Pharmakologie, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Germany
| Veröffentlicht: | 23. November 2018 |
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Gliederung
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Background: Frailty is a state of impaired physical function and heightened vulnerability to becoming dependent and other adverse outcomes. Frail elderly patients are at risk for falls, delirium and hospitalizations. The multimorbid elderly are more likely to be affected by polypharmacy and thus suffer adverse drug reactions, which in turn leads to further deterioration. Deprescribing is the systematic withdrawal of medications whose benefits no longer outweigh potential or existing harms [1]. In family conferences patients, their family, medical practitioners and in some cases caregivers are able to jointly prioritise treatment.
Materials and methods: 134 General practitioners in the regions of Düsseldorf and Rostock will recruit 670 community-dwelling frail elderly patients. GPs in the intervention group of this cluster randomised, multicentric trial will be trained to perform 3 family conferences for each patient, to jointly prioritise treatment following patients' needs and preferences, and to withdraw medications using a deprescribing guideline and algorithm. The control group will receive care as usual. The rate of hospitalizations after 6 and 12 months will be determined as the primary outcome.
The deprescribing guideline includes indications which are most prevalent in the multimorbid elderly [2], i.e. hypertension and diabetes among others. A literature search was performed focusing on lists of potentially inappropriate medication, deprescribing and appropriateness of different medication classes in the elderly. Additional information was collected from clinical practice guidelines. A first version of the guideline was tested in a workshop with general practitioners involved in the education of junior doctors.
Results: So far, each chapter of the deprescribing guideline contains criteria related to both the indication and the patient, to determine if a drug can be withdrawn. Additionally, drug-specific information is listed to brief the user on harms and precautions concerning the medication. Suggestions for a monitoring after drug discontinuation are also provided.
Conclusion: Family conferences in general practice may provide a setting that promotes shared decision-making regarding the prioritisation of treatment. Within that context, drug discontinuation may be facilitated by supplying GPs with structured information on deprescribing.
References
- 1.
- Scott IA, Hilmer SN, Reeve E, Potter K, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175:827-34.
- 2.
- van den Bussche H, Koller D, Kolonko T, Hansen H, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011;11:101.
