A Swiss Interprofessional Network for Reviewing Inappropriate Medication in Primary Care

The ageing population is leading to an increase in the prevalence of chronic conditions among older adults, often resulting in excessive polypharmacy. Polypharmacy, as well as the prescription of high-risk medications in this population, exposes them to more adverse effects, which can lead to falls and hospitalisation. This problem is of concern to healthcare professionals, whether they be general practitioners (GP), who have an overview of medical records, or dispensing pharmacists, who have an overview of medication. In Switzerland, these two professions still operate often in isolation from each other, but genuine collaboration is essential if we are to improve and manage polypharmacy among the elderly and limit the risks. Medication reviews are recognised as promising strategies for improving the quality of prescribing in patients with multiple medications.

This pilot trial does not randomly select participants and does not include a control group. It is a hybrid study that aims both to test the effectiveness of the intervention and to prepare for its implementation.

The study plans to include at least 250 patients from three groups of general practices in different settings. Participants will be aged 65 or older, take at least five chronic medications, and suffer from at least three chronic conditions. Individuals living in medical institutions will not be included.

Intervention:

• Step 1 (optional): Patients taking at least 10 chronic medications and experiencing adherence or side effect issues may benefit from a specialised consultation with a pharmacist.
• Step 2: The pharmacist identifies any medication-related issues for each patient and discusses them directly with the general practitioner in order to agree on the necessary adjustments.
• Step 3: During a medical appointment, the doctor and patient will decide together whether to implement the proposed changes.
• Step 4: The pharmacist will follow up after a few days and then again after 3 months.

Main objective: To assess whether this service is feasible in the context of the study.

Secondary objectives: Measure whether the intervention is well accepted (questionnaires and interviews) by the patients and healthcare professionals involved.

Exploratory objectives: Study the impact of the intervention on the quality of drug treatments, patients' quality of life and drug costs.

Inclusion criteria

• Age ≥ 65 years old;
• Regular use of at least 5 medications (chronic treatments, > 3 months);
• Patients with a minimum of 3 chronic diseases;
• Regular follow-up in a GP practice taking part in the project;
• Adequate understanding of French.
• Written informed consent

Exclusion criteria

• Residence in an institution (residential care facility, nursing home, etc.) ;
• Cognitive impairment preventing understanding or obtaining informed consent;
• Any other clinical situation deemed incompatible with participation, as decided by the GP in charge.