nearly 10 million Germans will be eligible by 2030 , each GP will need to take on about 216 medication reviews each year . Pharmacists could help with this , as medication review by pharmacists is now reimbursed in Germany . However , some practical issues , such as access to clinical information , will need to be resolved first , he concluded .
Potentially inappropriate prescribing ( PIP ) is associated with increased risks of adverse drug events , Professor Stephen Byrne ( University College Cork , Ireland ) told the audience . Furthermore , approximately 50 % of patients in secondary care are estimated to be recipients of PIP , he continued . This has led to calls for ‘ deprescribing ’ to protect patients from adverse effects . However , in practice this may not be easy . A number of tools for deprescribing have been developed and several large multicentre trials have evaluated the process . Many of the tools can be found at the website www . deprescribing . org , he noted . Medicines optimisation in older people is multifactorial and requires a range of measures , including discussion with the patients about what they want out of it , he concluded .
Appropriate polypharmacy Although often seen as a negative factor , appropriate polypharmacy can be a good thing , according to Carmel Hughes ( Professor of Primary Care Pharmacy , Queen ’ s University , Belfast ). However , getting the balance between ‘ many ’ and ‘ too many ’ is critical , she acknowledged .
A Cochrane review of interventions to increase the appropriate use of polypharmacy had shown that many studies lacked detailed descriptions and the effectiveness of interventions turned out to be weak . Evaluation of the evidence suggested that the challenge of improving
28 | Issue 102 | hospitalpharmacyeurope . com prescribing of appropriate polypharmacy was complex and required a correspondingly complex intervention – and this would call for changes in prescribing behaviour .
Professor Hughes and her team systematically identified the barriers to and facilitators of behaviour change and then considered the behaviour change techniques ( BCTs ) that would be needed . For example , if prompts and cues were needed to bring about a behaviour change , this might be achieved by simply placing a sticky note
Potentially inappropriate prescribing ( PIP ) is associated with increased risks of adverse drug events on a door as a reminder . In practice , moving from BCT to intervention package “ requires a balance between science and creativity ” said Professor Hughes . In this case the BCTs were embedded in the interventions . For example , when older patients who meet the inclusion criteria attend for scheduled appointments , the receptionist prompts the GP to perform a medication review .
The Medical Research Council ( MRC ) framework for developing complex interventions calls for pilot and pretesting before embarking on full scale study . With this in mind , the PolyPrime study was designed .
The Polyprime study is a pilot , cluster-randomised controlled trial ( cRCT ) trial of a theory-based intervention targeting prescribing of appropriate polypharmacy in primary care ( PolyPrime ) to assess the feasibility of a definitive cRCT of the PolyPrime intervention . This is a cross-border study involving six counties in Northern Ireland and in the Republic of Ireland . The study was started in August 2019 but
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