Article
Developing and finalising a deprescribing manual
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Published: | November 19, 2019 |
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Background: Many multimorbid and frail older patients are exposed to polypharmacy, which increases the risk of adverse drug events and hospitalisation. Deprescribing medications, whose benefits no longer outweigh the risks, may reduce the rate of hospitalisations and adverse outcomes. A priorisation of treatment will be examined during the COFRAIL study, a cluster-randomised controlled trial, as part of a complex intervention using a deprescribing manual in family conferences (funded by the Innovationsfonds 01VSF17053, registered with the German Clinical Trials Register DRKS00015055). To evaluate the feasibility and to create the final version of the deprescribing manual, a first draft was tested in the course of the trial’s pilot phase.
Materials and methods: Indications or topics for the manual were chosen according to their prevalence in geriatric patients and their potential for reducing drug burden. The recommendations within are based on lists of potentially inappropriate medications, clinical practice guidelines, deprescribing guidelines and studies. In the pilot phase of the study, general practitioners (GPs) took part in an expert workshop evaluating the usability of the manual by discussing deprescribing opportunities for a theoretical patient case. Furthermore, the relevance of topics covered by the manual was assessed. Feedback on the content and structure of the manual was gathered during the group discussion of the case study. Subsequently, four general practitioners piloted the manual in eight family conferences and commented on its usability in practice.
Results: According to the feedback of the GPs in the expert workshop, the general structure of the chapters was revised. Each chapter now outlines patient- and medication-related criteria, suggests how to prioritise drugs, states potential benefits of deprescribing and recommends monitoring strategies. We also created algorithms for each chapter which illustrate criteria for deprescribing stated in the manual. The revised version of the deprescribing manual covers 11 indications or topics, which the GPs all considered as relevant to the study population. This version of the deprescribing manual was well accepted in the family conferences during the pilot phase. Additionally, some aspects, such as indications for statins, potentially inappropriate medications (PIMs), and anticholinergics were further clarified in an appendix of the manual of the final version.
Conclusion: The deprescribing manual focuses on several frequently occurring and highly relevant conditions in geriatric pharmacotherapy. Its practicability and use will be further evaluated in the COFRAIL study.