Patient-Centred Deprescribing of Potentially Inadequate Medication in Patients with Polypharmacy (PARTNER) – study protocol of a cluster randomized trial

Sophie Peter, Achim Mortsiefer, Michaela Maas, Annette Härdtlein, Vita Brisnik, Christiane Muth, Svetlana Puzhko, Kerstin Bernartz, Hanna M. Seidling, Robert Moecker, Sophia Klasing, Laura K. Lepenies, Petra Kaufmann-Kolle, Patrizio Vanella, Michael Koller, Florian Zeman, Gunnar Huppertz, Yvonne Eberhardt, Tim Steimle, Nadine Steinkat, Tobias Dreischulte

Keywords: polypharmacy; interprofessional care; medication safety; potentially inadequate medication; deprescribing

Background:

Polypharmacy (5 or more medications) may increase the risk of adverse drug effects, especially in older patients. The guidelines recommend at least annual medication reviews, which are often complex and time-consuming for General Practitioners (GPs) and pharmacists. The PARTNER study will examine a coordinated and intensified collaboration between GPs and pharmacists in Germany and involving patients in decision making in order to optimize medication safety for drugs with high risk for adverse events (potentially inadequate medication, e.g. sedatives and anticholinergics).

Research questions:

Does a complex intervention consisting of intensified collaboration between GPs and pharmacists improve the quality of medication safety for older patients with polypharmacy?

Method:

Multicentered two-arm cluster randomized controlled trial involving 352 community-dwelling patients ≥65 years with polypharmacy, and 44 GP and pharmacists dyads. Intervention: a) educational training for GPs and pharmacists and intensified collaboration between these two groups of health professionals; b) patient education and coordinated patient counseling on medication safety. The effectiveness of the intervention will be evaluated after 6 months’ follow up by calculating the percentage of patients with the clinically relevant reduction of target potentially inadequate medications. Health economic evaluation and process evaluation will also be performed.

Results:

Recruitment starts in spring 2023. The study period is until 2025. We expect our intervention to improve communication between GPs, pharmacists and patients and improve the deprescribing of potentially inadequate medications.

Conclusions:

If the study shows a positive result, adoption into routine care in Germany will be sought. Due to the complexity and often time-consuming nature of medication reviews, increased collaboration between GPs and pharmacists, and involving patients in decision making may lead to a successful and sustainable improvement in medication safety for patients with polypharmacy in primary care.

Points for discussion:

How is a cooperation between GPs and pharmacists implemented in other European countries?

What parts of the intervention hold promise for better collaboration between GPs and pharmacists?