PIL:Polypharmacy Intervention Limburg: too much or too little?

Polypharmacy (the long-term use of 5 or more drugs) is a relevant and costly
health problem among the
elderly. The proportion of people with polypharmacy is rising as a result of
the increasing number of
people suffering from multimorbidity and the ageing of the population.
Guidelines for medical practice
are mainly disease-specific and pay little attention to disease-disease,
drug-disease and drug-drug
combinations and interactions with their potential harmful adverse effects.
A significant part of chronic medication is prescribed within a specific
medical specialism, often lacking
an integrated view of indications, treatment goals and medication. Polypharmacy
increases the risk of
side-effects and problems with patient compliance. At the same time
polypharmacy may induce
suboptimal treatment because the probability of underprescription increases
with the number of drugs
used, thus increasing the chance of inappropriate prescription.
The GP should play a pivotal role in the improvement of this process, with the
availability of
comprehensive data from his own practice, from the patient, the pharmacists and
from other medical
specialists. Furthermore, the GP is in a good position to discuss possibilities
to change medication with
the patient.

The ultimate goal of this project is to increase quality of life through
optimization of the medication use of
people with multimorbidity and polypharmacy. The goal is not to decrease the
number of medications
per se, but to optimize use of medication, and to assure appropriate
prescription.

This project consists of a randomized controlled trial. Randomization takes
place at practice level, to
avoid within-practice, inter-patient contamination. We will use the stepped
wedge design. Patients from all practices will eventually undergo intervention.

The intervention tested is an integral medication control and monitoring
system. Information of the
pharmacists is completed with the GPs* electronic patient record and with
information from the patients,
gathered by the nurse practitioner during home visits. GPs then formulate a
medication advice, which is
sent to other involved medical specialists to ask for their consent. The GPs
formulates a final advice and
discusses this with the patient. Modifications are carried through after the
patient*s consent.

During the intervention-study, the patient have to fill in 6 8 questionnaires,
depending on start of the intervention. A nurse practitioner will visit the
patient at home once, for an interview. Furthermore he will have 4
consultations with his GP and a monthly collection (instead of 3-monthly) of
his chronic medication at his pharmacist.
Expectations are, because of the integrated medication review, the patient will
suffer less adverse effects, medication interactions and will eventually
receive optimal medical treatment.