Optimising Medication With Focus on Deprescribing in Frail Older People With Multidose Drug Dispensing Systems

Overuse is common in frail older people with polypharmacy, especially in frail older users of multidose drug dispensing (MDD) systems. In this study, we will investigate the effect of a clinical medication review (CMR) with integration of deprescribing (toolbox) on the number of ceased and dose lowered medications (persistent after 6 months) compared to usual care in older users of MDD systems with hyperpolypharmacy.We will perform a controlled cluster-randomized trial in 38 community pharmacies. Per pharmacy, 10 older patients (>= 75) with hyperpolyfpharmacy (>10 medicines in use) with a MDD will be included. Pharmacists will receive training to perform the intervention, a 5-step CMR with a deprescribing toolbox (including deprescribing protocols): 1) patient interview; 2) pharmacotherapeutic analysis; 3) pharmacist and GP discuss actions; 4) actions are discussed with patient; 5) (two)weekly follow-up.

Inclusion Criteria:using a multidose drug dispensing systemhyperpolypharmacy patient (using 10 drugs or more)age: 75 years or olderExclusion Criteria:received a CMR in the previous 12 monthsincapacitatedpatients for whom the general practitioner is not the primary practionarexpected lifespan of less than six motnhspatients who live in a nursing home