Teaching physicians the GPGP method promotes deprescribing in both inpatient and outpatient settings

Abstract

Background In complex older patients, inappropriate medication use and polypharmacy (IMUP) are commonplace and increasing exponentially. Reducing IMUP is a challenge in multiple clinical contexts, including acute admission and family practice, due to several key barriers. In the global effort against this epidemic, educational programs geared toward changing physicians’ prescribing patterns represent an important means of promoting deprescribing. Methods This is a nonrandomized, controlled interventional study investigating polypharmacy outcomes and prescribing patterns in patients whose physicians were trained in the Good Palliative-Geriatric Practice (GPGP) method, an algorithm for the reduction of polypharmacy, with patients whose physicians were not. Training involved a one-time, full-day workshop led by a senior geriatrician. Two separate settings were examined. In the inpatient setting, one internal medicine ward was trained and compared with another ward which was not trained. In the family practice setting, 28 physicians were trained and compared with practices of 15 physicians not trained. Patients were above the age of 70, representative of the general geriatric population, and not terminally ill. Results In the inpatient arm, the intervention group ( n = 100) experienced a decrease in medications prescribed from admission to discharge of 18.5%, compared with a decrease of 1.9% in the control group ( n = 100, difference between groups p < 0.0001). In the outpatient arm, the intervention group ( n = 100) experienced a decrease in medication number of 6.1% compared with 0.07% in the control group ( n = 100, difference between groups p = 0.001) over a 6-month period. Preferential decreases in specific drug classes were observed in both groups, including benzodiazepines, psychotropics, and antihypertensives. Conclusions A one-time educational intervention based on GPGP can change prescribing patterns in both outpatient and inpatient settings leading to a moderate reduction in polypharmacy. Future work should focus on longitudinal interventions, and longer-term clinical outcomes such as morbidity, mortality, and quality of life.

Inappropriate medication use and polypharmacy in older people

“…Barriers to deprescribing include deficiencies in medical education, the practise of defensive medicine, and systematic influence from the pharmaceutical industry 189. But there is cause for optimism, as some groups report greater receptiveness on the part of doctors and patients to deprescribing, especially when educated on the matter in diverse contexts 101112. A new course must be charted to overcome these barriers and begin systematically prioritising appropriate prescribing.…”

Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review

“…The tools we most commonly found were the screening tool of older people’s prescriptions and the screening tool to alert the right treatment (STOPP/START) [ 19 ] (n = 17 review papers) followed by the Beers Criteria [ 20 ] (n = 12), Medication Appropriateness Index (MAI) [ 21 ] (n = 4), and Fit fOR The Aged list (FORTA) [ 22 ] (n = 4). These tools, as well as STOPPFrail [ 23 ], the Norwegian General Practice criteria (NORGEP) [ 24 ], the (EU)(7)-PIM list [ 25 ], the PRISCUS list [ 26 ], the Systematic Tool to Reduce Inappropriate Prescribing (STRIP) [ 27 ], Good Palliative–Geriatric Practice (GP-GP) [ 28 ], the Individualized Medication Assessment and Planning program (IMAP) [ 29 ], and the Zhan Criteria [ 30 ] are the main criteria used to review drug therapy in light of identified iterations. They are used by professionals, mainly physicians and pharmacists, to identify potential drug interactions, which may have a negative impact on the health of the patient.…”

Prevalence, predisposing factors and strategies to reduce polypharmacy among older patients in Poland

“…the MAI (Medication Appropriateness Index) [27] or the Good-Palliative-Geriatric Practice Algorithm [28]. Reducing exposure to potentially inappropriate medication is associated with a lower risk of adverse drug reactions and hospitalization in elderly individuals, however has no influence on mortality [29].…”