Multidisciplinary Management of Complex Polypharmacy in an Integrated Care Program for Older Persons

Abstract Background Complex polypharmacy management is common in the care of frail older adults. Research has demonstrated that multidisciplinary management of complex can be effective at reducing potentially inappropriate prescribing. We sought to review our own practice in an Integrated Care Program for Older Persons setting, where multidisciplinary management of polypharmacy is commonplace. Methods As part of our new patient assessments, patient’s medications and their management are discussed at a multidisciplinary meeting, where feedback on improved adherence and potential changes are made. We reviewed the notes of new patient’s in the previous year in relation to the medications prescribed, in addition to changes made. Continuous data was described by way of means/standard deviations, and categorical data was described by way of numbers/proportions. Results The notes of 61 patients who completed a comprehensive geriatric assessment were reviewed. The mean age was 84.5 (SD=6.1), mean clinical frails scale was 5 (SD=1.2), and 52.5% (n=32) were women. The mean number of medications at initial assessment was 10.3 (SD=4.3), with 80.3% (n=49) needing support taking medications, and 57.4% (n=35) having their medications blister packed. At least one potentially inappropriate medication was identified in 31.1% (n=19) patients, with 44.3% (n=27) having at least one medication de-prescribed and 41% (n=25) having at least one new medication started. De-prescribed medications included nutritional supplements (n=6), beta-blockers (n=5) and proton pump inhibitors (n=3), with medications started including vitamin D/calcium (n=9) and paracetamol (n=3). Conclusion Multidisciplinary management of complex polypharmacy in frail older adults may be effective, with further research required.