Introduction
The growing population of older people with multiple chronic conditions
and polypharmacy challenges healthcare systems
worldwide1,2. The term polypharmacy have no single
agreed definition, but the most reported is the daily use of five or
more medications3. Polypharmacy can provide
significant health benefits to patients; however, it also increases the
risk of medication‐related harm3. Therefore,
increasing focus is being placed on differentiating between appropriate
and inappropriate medication rather than the number of medications
alone4.
In general, older people and people with chronic diseases are at greater
risk of experiencing polypharmacy and inappropriate medication. These
patient groups often require treatment for multiple chronic conditions
and are more prone to experiencing adverse drug events e.g., due to
drug-drug interactions and age-related alterations in pharmacokinetics
and pharmacodynamics5. Adverse effects can have
serious implications for patient in terms of reduced quality of life,
hospital admission, and premature death6.
Additionally, adverse effects can be misinterpreted as newly emerged
symptoms or conditions, which can lead to further prescribing, a
phenomenon referred to as “the prescribing
cascade”6.
Polypharmacy interventions as e.g. medication reviews are considered
valuable to reduce potentially inappropriate medications through
deprescribing recommendations7. Deprescribing is
defined as the planned and supervised process of dose reduction or
stopping of medications that might be causing harm, or which may no
longer have a benefit8. During a medication review,
the patient’s complete medication list is systematically and critically
reviewed in relation to indications, effects, side effects,
interactions, and adherence based on leading evidence and knowledge
about the patient, including individual needs and
preferences9.
In the last decade, numerous medication review intervention studies have
been conducted with the aim to reduce the number of medications and
improve the overall appropriateness of prescribing for
patients10. A recent review of reviews on polypharmacy
interventions in the primary care setting found that, overall, these
interventions were associated with reductions in potentially
inappropriate prescribing and improved medication
adherence10. However, in medication review and
deprescribing studies, outcomes are frequently medication-related (e.g.,
number of medications) or resource-related (e.g., cost, general practice
visits, or hospitalization)8,9. There is limited
evidence of the effectiveness of the interventions on clinical outcomes
of importance to patients10.
Therefore, in a primary care settled quality improvement project aiming
to deprescribe medication through a medication review intervention, we
investigated how the implemented medication changes affected
health-related outcomes in real-life patients.