LESS-PHARMA Study: Identifying and Deprescribing Potentially Inappropriate Medication in the Elderly Population with Excessive Polypharmacy in Primary Care

Int J Environ Res Public Health. 2022 Oct 14;19(20):13241. doi: 10.3390/ijerph192013241.

Abstract

Potentially inappropriate medication (PIM) increases adverse drug reactions and mortality, especially in excessively polymedicated patients. General practitioners are often in charge of this process. Some tools have been created to support them in this matter. This study aimed to measure the amount of potentially inappropriate medication among excessively polymedicated patients using several supporting tools and assess the feasibility of these tools in primary care. Several explicit deprescribing criteria were used to identify potentially inappropriate medications. The level of agreement between all the criteria and the acceptance by the general practitioner (GP) was also measured. We analysed whether the drugs proposed for deprescribing were eventually withdrawn after twelve months. The total number of drugs prescribed was 2038. Six hundred and forty-nine drugs (31.8%) were considered potentially inappropriate by at least one of the tools. GPs agreed with the tools in 56.7% of the cases. In a 12-month period, 109 drugs, representing 29.6% of the drugs that GPs agreed to deprescribe, were withdrawn. Elderly excessively polymedicated patients accumulated a great number of PIMs. The use of deprescribing supporting tools, such as explicit criteria, is feasible in primary care, and these tools are well accepted by the GPs. However, eventual withdrawal was carried out in less than half of the cases.

Keywords: deprescribing; elderly; polypharmacy; potentially inappropriate medication.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Deprescriptions*
  • Humans
  • Inappropriate Prescribing / prevention & control
  • Polypharmacy
  • Potentially Inappropriate Medication List*
  • Primary Health Care

Grants and funding

This research received no external funding, but received support for publication from the Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), funded by the Ministry of Health ISCIII-RICORs awards RD21/0016/0009, and from European Union ERDF funds. The funders had no role in the study design, data collection, management, analysis, interpretation, decision to publish, or preparation of the manuscript.