MediQuit, an Electronic Deprescribing Tool for Patients on Polypharmacy: Results of a Feasibility Study in German General Practice

Abstract

Background Deprescribing is an important task for general practitioners (GPs) in the face of risky polypharmacy. The electronic tool "MediQuit" was developed to guide GPs and patients through a deprescribing consultation that entails a drug-selection phase, shared decision making, and advice on safe implementation. Objectives A pilot study was conducted to determine the target group of patients that is selected for consultation and to assess the impact, patient involvement, and feasibility of the tool. Methods This was an uncontrolled pilot study. GPs from two German regions were invited to use MediQuit in consultations with a view to deprescribing one drug, if appropriate. They selected patients on the basis of broad inclusion criteria. Collected data entailed participants' characteristics, patients' medication lists, deprescribed drugs, and feasibility assessments. Patients were contacted shortly after the consultation and again after 4 weeks. Results In total, 16 GPs agreed to participate, of whom ten actually performed deprescribing consultations. They selected 41 predominately older patients on excessive polypharmacy. Deprescribing was achieved in 70% of consultations in agreement with patients. Drugs deprescribed were symptom-lowering and preventive drugs (mainly anatomical therapeutic chemical classes A and C). GPs found MediQuit useful in initiating communication on this issue and enhancing deliberations for a deprescribing decision. The median consultation length was 15 min (interquartile range 10-20). At follow-up, GPs and patients infrequently disagreed on which drug(s) was discontinued, and GPs rated patient involvement higher than did patients themselves. Discussion MediQuit assists in identifying concrete deprescribing opportunities, patient involvement, and shared decision making. The three-step deprescribing procedure is well-accepted once initial organizational efforts are overcome. After revision, further studies are needed to enhance the quality of evidence on acceptance and effectiveness.

Prevalence of polypharmacy in community-dwelling older adults from seven centres in five European countries: a cross-sectional study of DO-HEALTH

“… 65 69 A pilot study among 16 general practitioners in Germany found that an electronic tool may assist in identifying deprescribing opportunities and promote patient involvement and shared decision making. 64 Our findings suggest that even among relatively healthy older adults polypharmacy is common, which makes this population also a target for deprescribing interventions.…”

“…In Portugal, an ongoing nationwide three-phase study on deprescribing is investigating barriers and facilitators of deprescribing perceived by older adults and their acceptance to have regular medications deprescribed 65 69. A pilot study among 16 general practitioners in Germany found that an electronic tool may assist in identifying deprescribing opportunities and promote patient involvement and shared decision making 64. Our findings suggest that even among relatively healthy older adults polypharmacy is common, which makes this population also a target for deprescribing interventions.…”

“…Notably, about 50% of older adults take at least one unnecessary medication56 and less than 50% have a clear understanding of pharmacotherapy purpose 57. In this context, efforts to minimise polypharmacy and deprescribe unnecessary or inappropriate medications were described around the world 58–69. Recently, findings from a Swiss cluster randomised clinical study among 46 primary care physicians suggested that a patient-centred deprescribing intervention may reduce polypharmacy among old multimorbid patients 67.…”

Recent Updates on Risk and Management Plans Associated with Polypharmacy in Older Population

“…Hence, it becomes imperative for a physician to examine patient approach on goals of therapy. It also takes into consideration the basic parameters of chronic conditions and medications and affords prime concern regarding prescription to slow down the disease progression along with minimizing the health decline [ 36 , 37 ]. It has been observed that only a limited percentage of the elderly community debate health-related decision-making priorities with their primary care physicians.…”

MediQuit – an electronic deprescribing tool: a pilot study in German primary care; GPs’ and patients’ perspectives

“…Here, patients and physicians review and assess the patients’ medication regimen and identify, weigh, and decide on opportunities for improvement. First evaluation of MQu by our team indicate satisfactory effectiveness with 70% of patients reporting drug discontinuation [ 15 ].…”