gms | German Medical Science

Background: Frail elderly patients have an increased risk of adverse drug effects, falls and hospital admissions due to polypharmacy, potentially inappropriate medication (PIM) or a high drug burden index. A promising way to decrease these risk factors in primary care is depicted by reducing polypharmacy through shared decision-making in medication management and promoting deprescribing. The aim of this study was to examine the effects of family conferences on deprescribing and patient safety in the frail elderly with polypharmacy living at home.

Materials and Methods: Frail elderly patients have an increased risk of adverse drug effects, falls and hospital admissions due to polypharmacy, potentially inappropriate medication (PIM), or a high drug burden index. A promising way to decrease these risk factors in primary care is depicted by reducing polypharmacy through shared decision-making in medication management and promoting deprescribing. The aim of this study was to examine the effects of family conferences on deprescribing and patient safety in the frail elderly with polypharmacy living at home.

Methods: The COFRAIL cluster-randomised, controlled interventional study included 114 general practitioners (GPs) and 623 frail, elderly (≥ 70 years) outpatients with polypharmacy (≥ 5 drugs/d). Patients in the intervention group (IG) participated each in three consecutive family conferences, which were led by the GP and joined by a family caregiver and/or nursing services. Data were collected at baseline (T0), after 6 (T1) and after 12 months (T2). Patients in the control group (CG) received care as usual. The primary outcome was the number of hospitalisations within 12 months. These results were calculated and adjusted for the intention-to-treat population (ITT-population) as well as the per protocol population (PP-population). Secondary outcomes included an evaluation of the medication intake of the PP-population, a sub-evaluation (in patients with complete medication data) of PIM intake according to the PRISCUS- and EU(7)-PIM-list and a DBI calculation according to the German-DBI-List.

Results: The hospitalisation rate for the ITT-population (n = 510 patients) and PP-population (n = 385 patients) did not differ significantly between IG (ITT: 0.98 ± 1.72; PP: 0.73 ± 1.12) and CG (ITT: 0.99 ± 1.53; PP: 0.79 ± 1.11). The PP analysis showed a mean drug intake of 8.98 ± 3.56 medicines per patient in the IG at T0. This number decreased to 8.11 ± 3.21 at T1 (p < 0.001) and remained almost constant at 8.49 ± 3.63 at T2 (p = 0.073). In comparison, the patients in the CG had an intake of 9.24 ± 3.44 medicines per patient with no relevant change during the observation period. The sub-analysis of patients with complete medication data (n = 347) revealed that 22.2 % of patients in the IG were taking at least one PRISCUS-PIM at T0. This number decreased to 17.6 % at T1 (p = 0.50) and remained almost constant at 18.2 % at T2 (p = 0.50). The respective values for the EU(7)-PIM-list were 81.8 % at T0, 75.6 % at T1 (p = 0.04), and 76.1 % at T2 (p = 0.72). In the CG PIM use was prominent in 21.6 % of patients according to the PRISCUS list and 86.6 % of patients according to the EU(7)-PIM-list and remained almost constant for the EU(7)-PIM-list over time. The mean calculated DBI per patient in the IG decreased from 0.76 ± 0.83 at T0 to 0.66 ± 0.75 at T1 (p < 0.01) and raised to 0.73 ± 0.81 at T2 (p< 0.3). Only slight changes occurred in the CG with 0.70 ± 0.84 at T1.

Conclusion: In our study, a shared prioritisation within family conferences led to a statistically significant reduction of medications taken, EU (7)-PIM, and the DBI in the intervention group after 6 months (T1). Although hospitalisation rate was not reduced by deprescribing, the intervention can be described as a safe way reducing daily medication intake. Further investigations are needed to define the patient population having the greatest benefit from deprescribing and evaluating long-term effects.