66 Preventing overtreatment in older age by prioritising medicines

Abstract

Objectives Reducing inappropriate and harmful medicines in older people with comorbidity is a major public health issue. GPs and pharmacists play a pivotal role in optimising medicines and reducing treatment burden. This includes reviewing medicines to confirm they are (still) needed/safe and align with patient goals. Medication reviews conducted by pharmacists aim to resolve problems associated with polypharmacy and involve recommendations to the patient’s GP on how to do this. However, there are barriers to uptake and limited evidence underpinning medication reviews. Our study aimed to explore GP and pharmacists’ views on the role of patient goals and preferences in medication reviews and deprescribing. Method Semi-structured interviews were conducted with GPs (n=25), pharmacists (n=11) who refer to and conduct medication reviews; with varying background characteristics and experience levels. Transcribed audio-recordings of the interviews were coded using Framework Analysis. Results Most participants recognised the importance of getting a sense of patient’s goals/preferences in relation to medicines. However, often these discussions were initiated by the patient, some participants tended to interpret goals only in terms of clinical outcomes (i.e. therapeutic index) and goals were not routinely discussed. Overall, participants considered medication reviews useful for preventing medication errors, reducing treatment burden and to support deprescribing. However, some GPs expressed doubts about the effectiveness of reviews, suggesting they may be limited in what they can achieve as only one aspect of patient care. Important barriers were highlighted related to patients (resistance to the review, misunderstanding about the aim); pharmacists (importance of patient goals/preferences being reflected in recommendations, reviews targeted to high-need patients with recommendations actioned by GPs for patients to benefit) and GPs (limited information from the GP at referral, limited follow-up afterwards and recommendations not being actioned). Conclusions Participants reported a range of benefits for medication reviews in terms of optimising care and reducing medication burden for older people. However, we identified limitations importantly goals and preferences may not be routinely incorporated in decision-making about medicines and some GPs are doubtful as to the clinical benefit of medication reviews. This may influence barriers reported by participants such as patient resistance to reviews, misunderstanding of the purpose and limited follow up afterwards. This study highlights the challenges GPs and pharmacists face in collaboratively managing polypharmacy and providing care that aligns with patient goals and preferences.