(130) PARTNER pilot study: Interprofessional clinical pathway to patient-oriented deprescribing of psychotropic and anticholinergic medications in elderly patients with polypharmacy

Background: Several psychotropic and anticholinergic drugs are known as potentially inappropriate medications and can increase the risk of adverse drug reactions, especially in older patients with polypharmacy. However, their deprescribing (discontinuation or dose reduction) is often complex and time-consuming. Pharmacists can potentially assist general practitioners (GPs) in this regard, provided that both professions adopt a coordinated approach and work together.

Objectives: The aim of the PARTNER pilot study was to test the feasibility, acceptability, potential benefits and barriers to implementing the PARTNER intervention as well as key processes of a planned cluster-randomized trial.

Methods: The study design was a single-arm prospective intervention study. Intervention components included (1) educational material for GPs and pharmacists on target medications, (2) a moderated interprofessional case conference, (3) a patient-pharmacist consultation using medication-specific empowerment brochures, medication analysis, and (4) a patient-GP consultation. Data were collected by the study team and health care providers at defined intervention steps and through semi-structured interviews. Quantitative and qualitative data were integrated as part of a mixed-methods approach.

Results: Four clusters, each consisting of a GP practice and at least one collaborating community pharmacy, were subjected to the intervention. Among eligible patients (≥ 65 years with polypharmacy, use of ≥ 1 psychotropic/anticholinergic drug and not meeting exclusion criteria), a total of 30 patients were randomly selected and recruited by participating GPs. More than half of patients enrolled had antidepressants (18 (60%)) as the target medication (for either insomnia or depression), 12 (40%) had either pregabalin or gabapentin, and two (7%) patients had anticholinergic urospasmolytics. Half of the patients had more than one target medication and received more than one empowerment brochure. After patient-GP consultation, deprescribing (discontinuation or dose reduction) of one or more target medication was agreed in 16 (53%) patients.

Conclusions: The findings of the pilot study confirm the feasibility of implementing the PARTNER intervention in German primary care as well as the potential of the PARTNER intervention to stimulate deprescribing of psychotropic/anticholinergic medication. A multicenter confirmatory cluster-randomized trial with process evaluation is currently evaluating its effectiveness in reducing the use of target medication in German primary care.