Introduction

The growing population of older people with multiple chronic conditions and polypharmacy challenges healthcare systems worldwide1,2. The term polypharmacy have no single agreed definition, but the most reported is the daily use of five or more medications3. Polypharmacy can provide significant health benefits to patients; however, it also increases the risk of medication‐related harm3. Therefore, increasing focus is being placed on differentiating between appropriate and inappropriate medication rather than the number of medications alone4.
In general, older people and people with chronic diseases are at greater risk of experiencing polypharmacy and inappropriate medication. These patient groups often require treatment for multiple chronic conditions and are more prone to experiencing adverse drug events e.g., due to drug-drug interactions and age-related alterations in pharmacokinetics and pharmacodynamics5. Adverse effects can have serious implications for patient in terms of reduced quality of life, hospital admission, and premature death6. Additionally, adverse effects can be misinterpreted as newly emerged symptoms or conditions, which can lead to further prescribing, a phenomenon referred to as “the prescribing cascade”6.
Polypharmacy interventions as e.g. medication reviews are considered valuable to reduce potentially inappropriate medications through deprescribing recommendations7. Deprescribing is defined as the planned and supervised process of dose reduction or stopping of medications that might be causing harm, or which may no longer have a benefit8. During a medication review, the patient’s complete medication list is systematically and critically reviewed in relation to indications, effects, side effects, interactions, and adherence based on leading evidence and knowledge about the patient, including individual needs and preferences9.
In the last decade, numerous medication review intervention studies have been conducted with the aim to reduce the number of medications and improve the overall appropriateness of prescribing for patients10. A recent review of reviews on polypharmacy interventions in the primary care setting found that, overall, these interventions were associated with reductions in potentially inappropriate prescribing and improved medication adherence10. However, in medication review and deprescribing studies, outcomes are frequently medication-related (e.g., number of medications) or resource-related (e.g., cost, general practice visits, or hospitalization)8,9. There is limited evidence of the effectiveness of the interventions on clinical outcomes of importance to patients10.
Therefore, in a primary care settled quality improvement project aiming to deprescribe medication through a medication review intervention, we investigated how the implemented medication changes affected health-related outcomes in real-life patients.