A Clinical Medication Review Focused on Deprescribing in Older Patients With Hyperpolypharmacy: A Mixed-Methods Feasibility Study

Abstract

To address challenges in deprescribing, we investigated the feasibility of an intervention consisting of a clinical medication review (CMR) focused on deprescribing, supported by a training programme for healthcare providers (HCPs) among older patients with hyperpolypharmacy (≥ 10 chronic medications) in primary care. A mixed-methods feasibility study was conducted in six Dutch community pharmacies using Bowen's framework. The intervention comprised HCP training and a five-step deprescribing-focused CMR. Within 6 Bowen domains, 18 outcomes were assessed through (patient) questionnaires, interviews (patients, HCPs), process parameters, and medication dispensing data. Five pharmacists conducted CMRs with 24 patients (median age: 84.5 years). The intervention was well accepted by patients and HCPs. However, barriers emerged regarding implementation and practicality. Consultations lacked complete discussion of patient concerns, and pharmacists reported varying levels of confidence in making deprescribing decisions. Time constraints limited the incorporation of deprescribing into CMRs. On average, 1.3 medications per patient were deprescribed. Within a setting of motivated and CMR-experienced HCPs, adding a focus on deprescribing to CMRs for older patients with hyperpolypharmacy was feasible and well received. Feasibility was supported by high acceptability and deprescribing potential, though barriers in implementation and practicality indicate the need for further evaluation in broader primary care settings.