An evaluation of polypharmacy medication reviews in GP practices

Abstract

Polypharmacy, defined as the concurrent use of four or more medications by a single patient, is ever-increasing. It enhances the risk of adverse drug reactions (ADRs) and can represent a huge burden to patients. Medication reviews are the proposed panacea for reducing such problematic polypharmacy. These reviews conducted on patients aged 65 years or over can be aided by activation of the STOPP/START toolkit, an electronic tool that gives alerts, specific to a patient’s current medication regime, to recommend that GPs stop and/or start certain medications. Unique to this toolkit, the alerts are significantly associated with the Royal College of General Practitioners (RCGP) prescribing safety indicators – indicators designed to reduce ADRs – and, thus, the toolkit attempts to enhance patient safety. The aim of this study was to determine whether the STOPP/START toolkit improves medication reviews conducted on elderly polypharmacy patients. Forty patients aged 75 years or over, all of whom were registered with a North Kirklees commissioned GP practice, were currently prescribed ten or more medications, and had received a STOPP/START medication review, formed the study’s participant cohort. Recruited patients were asked a series of questions via a retrospective telephone interview to help determine the patient-perceived usefulness of, and satisfaction with, the medication review. Data regarding the number of alerts identical or similar to the RCGP prescribing safety indicators of defined ‘high’ (level 3) or ‘extreme’ (level 4) risk that were triggered and resolved during the North Kirklees commissioned STOPP/START medication reviews was also accessed and analysed. This helped to determine whether improved patient safety could be deemed an attribute of STOPP/START. It was found that 75% of patients believed their medication review was useful, regardless of whether any medications were stopped and/or started. If medications were stopped and/or started, patients felt greater involvement in and heightened satisfaction with the change(s) made if change(s) were based on STOPP/START recommendations (p<0.1). Furthermore, in North Kirklees, 388 STOPP/START alerts linked to level 3/4 RCGP indicators were resolved; these resolutions potentially prevented 78 hospital admissions. This study suggests that the stopping and/or starting of medications is not crucial in establishing overall patient satisfaction in medication reviews. Instead, it would seem that elderly patients merely desire the opportunity to discuss their medications with a healthcare professional. However, the STOPP/START toolkit can help to improve patient safety, and can better engage patients in decisions for medication change(s), heightening patient satisfaction with the change(s). This suggests that activation of the STOPP/START toolkit in polypharmacy medication reviews conducted on the elderly would be beneficial.