Developing a strategy in primary care to promote appropriate medication use for patients with advanced illness

80% of patients with advanced illness use potentially inappropriate medication, and in such a vulnerable population this can lead to falls, medication interactions, hospitalisations, and, a poorer quality of life. Despite national guidelines to promote deprescribing, this is poorly enacted in primary care practice, either occurring too late, or not at all. This study aims to develop a strategy to enable appropriate medication use for patients with advanced illness specific for Dutch primary care.

Methods/ A multimethods study was conducted focusing on patients with advanced illness in primary care, including: (1) scoping review to identify deprescribing interventions; (2) a retrospective cohort study of medication use; and, (3) a qualitative study examining the factors influencing appropriate medication use. Employing a behavioural change model, an expert group of clinicians, patient stakeholders and researchers developed a strategy specific for Dutch primary care.

Results/ The results demonstrated that patients and health professionals identified the importance of deprescribing, however, lacked a systematic approach and guidance to integrate this into practice. A multidisciplinary (GPs, nurses and pharmacists) strategy was developed focusing on four key elements: increasing patient awareness and participation, education for health professionals, incorporating existing guidelines into practice, and implementing a routine process for appropriate prescribing, including the identification of patients, inappropriate medications, and medications reviews.

Conclusions/ Appropriate prescribing for patients with advanced illness can be promoted through supporting health professionals to routinely and systematically engage in this process, through education, employing existing guidelines, and engaging with patients and the multidisciplinary primary care team.