107 Systematic medication review in general practice – a collaboration between clinical pharmacology and general practice

Abstract

Objectives It is estimated that almost 30.000 elderly are hospitalized in Denmark each year, as a result of preventable adverse events due to prescription drugs. In patients older than 60 years of age, 9% of all hospital admissions are due to adverse drug reactions and polypharmacy increase the risk significantly. Hence, it is important to reduce the number of unnecessary medical treatments among the elderly. The objective of this study was to develop a method of conducting a systematic medication review in general practice as a collaboration between The Department of Clinical Pharmacology and General Practice. Method A medication review was offered general practitioners in the Capital Region of Denmark in 2017. The project proceeded throughout 2017 and was a collaboration between the Department of Clinical Pharmacology, a team of medication consultants and the general practitioners of the included patients. The Department of Clinical Pharmacology performed a thorough medication review of the selected patients, which was sent to the medication consultant. Subsequently the medication consultants offered a visit at the general practitioner to discuss potential changes to the individual patient’s medication. At the visit, the general practitioners acceptance rate of the proposed medication changes was registered. Patients older than 64 years of age and with more than 5 medications were included. The Department of Clinical Pharmacology was given seven days to conduct the medication review, returning it to the medication consultant seven days before the visit. Results Of the included patients 13 medication reviews were not performed due to failure to comply with the time schedule. Further eight were not performed due to lack of clinical information which we were unable to obtain by contacting the general practitioner. In total 113 patients were included and their medication reviewed. The median age of the patients was 75 years (interquartile range 69–82 years) and 58% were female. A total of 1791 prescriptions were reviewed and 807 (45%) changes were proposed. Of these, discontinuation was the most frequent proposed change (57%), whereas change of medication (22%), reduction of dose (15%) and increase of dose (6%) were less frequent. The time schedule for the medication review was difficult to meet, and canceled at the end of the project. Conclusions In summary, we found that almost half of the prescriptions gave rise to a proposed medication change, with discontinuation being the leading proposal. This may indicate an overmedication in general practice for this group of patients. The medication review was very thorough with high quality clinical information. It involved several steps and several health professionals, hence it was a very time consuming model with a time consumption of several hours. Therefore it is proposed, that this model will only be reserved for elderly, complex polypharmacy patients.