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Medication changes implemented during medication reviews and factors related to overprescribing: post-hoc analyses of a randomized clinical trial in geriatric outpatients with polypharmacy
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  • Jonatan Kornholt,
  • Shafika Feizi,
  • Alexandra Hansen,
  • Jannie Laursen,
  • Karl Johansson,
  • Lene Reuther,
  • Tonny Petersen,
  • Eckart Pressel,
  • Mikkel Christensen
Jonatan Kornholt
Copenhagen University Hospital, Bispebjerg and Frederiksberg

Corresponding Author:jonatankornholt@outlook.com

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Shafika Feizi
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Alexandra Hansen
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Jannie Laursen
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Karl Johansson
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Lene Reuther
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Tonny Petersen
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Eckart Pressel
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Mikkel Christensen
Copenhagen University Hospital, Bispebjerg and Frederiksberg
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Abstract

Aims: To describe the medication changes implemented during physician-led medication reviews that resulted in improved health-related quality of life; and to explore factors that could identify patients with overprescription.
Methods: Post-hoc analyses of data from a pragmatic, non-blinded, randomized clinical trial investigating a medication review intervention (NCT03911934) in 408 geriatric outpatients taking \(\geq\)9 medicines.
Results: The most frequent medicine change in the medication review group (n=196) was discontinuation (26% of the medicines) due to lack of indication (72% of the discontinuations). After 13 months, 82% of the discontinued medicines were persistently discontinued. The medicines most often discontinued in the medication review group compared with usual care included: metoclopramide (11/5=73% discontinued vs 1/12=8% in usual care), acetylsalicylic acid (20/48=42% vs 2/47=4%), simvastatin (18/48=38% vs 2/58=3%), zopiclone (23/59=39% vs 4/54=7%), quinine (9/14=64% vs 6/16=38%), citalopram (4/18=22% vs 0/20=0%), and tramadol (18/37=49% vs 8/30=27%). Factors associated with the number of overprescribed medicines included: number of prescribed medicines (8% increase per medicine), Drug Burden Index (15% increase per 1 increase), and patient motivation for medicine changes (26% less if not motivated). Prescriptions of metoclopramide, iron preparations, antidepressants other than SSRIs, NSAIDs, or drugs for urinary incontinence were associated with a higher number of overprescribed medicines.
Conclusion: Medication reviews can be used to persistently discontinue overprescribed medicines in older polypharmacy patients. Motivation for having their medicine changed, treatment with a higher number of medicines, and a higher burden of sedative and anticholinergic drugs characterized patients most likely to benefit from physician-led medication reviews.
13 Nov 2022Submitted to British Journal of Clinical Pharmacology
14 Nov 2022Submission Checks Completed
14 Nov 2022Assigned to Editor
14 Nov 2022Review(s) Completed, Editorial Evaluation Pending
12 Dec 2022Reviewer(s) Assigned
06 Mar 2023Editorial Decision: Revise Major
19 May 20231st Revision Received
19 May 2023Submission Checks Completed
19 May 2023Assigned to Editor
19 May 2023Review(s) Completed, Editorial Evaluation Pending
21 May 2023Editorial Decision: Accept