MODIFY or Medication Review in Primary Care Study

A third of older people take five or more regular medications (polypharmacy) potentially increasing the risk of side-effects, hospital admission and death, with higher risk among people living with frailty. National recommendations suggest that medications taken by frail older people should be reviewed annually by GPs to identify and reduce/ stop inappropriate medications (deprescribing). Yet this does not happen routinely due to GPs' lack of time, increased workloads and worries about stopping medicines. Recent recommendations suggest involving other non-medical prescribers such as practice-pharmacists and advanced nurse practitioners (ANPs) in reviewing medications. However, it is unknown how staff could work together most effectively and whether they have any training needs.This research will investigate how practice-pharmacists, ANPs and GPs could best work together with patients living with frailty to perform regular medication reviews. There are four work packages (WPs).Review literature to identify what makes a successful medication review and how to safely deprescribe.Interviews with GPs, practice-pharmacists, ANPs, frail older patients and carers will investigate where medication review should take place, the role of involved parties, type of medications that could be deprescribed, staff training needs, barriers and facilitators for implementation, and strategies to address them.Information from WP1&2 will be used to develop the intervention: a structured medication review process using pharmacists, ANPs and GPs and involving frail patients and their families in decisions about medications. This will be refined through workshops with service users, clinicians and commissioners. A training programme to implement the intervention and increase staff confidence in deprescribing will be developed alongside the intervention.Feasibility study for staff in four GP practices to be trained and to implement the intervention.(this will be subject to further amendment).

Eligibility criteria for WP2Patients:Inclusion criteriaAged 65 and overFrail, (as judged by their health care professional, if applicable)Prescribed multiple medications (10+), as determined by their health care professionalAble to give informed consentExclusion criteriaAged under 65Severe cognitive impairment, as judged by their health care professionalInformal carers/ relatives eligibility criteriaInclusion criteriaAn informal carer/ relative of a frail patient (aged 65 and over) who is taking multiple medications, as identified by a health care professionalAn informal carer/ relative of a patient (aged 65 and over) living with severe dementia who is taking multiple medications, as identified by a health care professionalAble to consentHealth care professional eligibility criteria• A health care professional based in GP surgeries in Wessex (eg. GPs, practice-pharmacists, advanced nurse prescriber (ANPs) who works with older people living with frailty, who are prescribed multiple medications.