How did patients feel about their medication review? Patient-reported satisfaction of medication reviews as part of a complex intervention for polypharmacy in general practice: IMPPP Trial

Problem

Polypharmacy is common and associated with patient safety risks. Polypharmacy management necessitates balancing therapeutic benefits and risks with fluctuating clinical and patient priorities. The Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial evaluated the effectiveness of a complex intervention to optimise medication use for patients with polypharmacy in general practice. This presentation details patients’ experience of their medication review.

Approach

The IMPPP trial was a multicentre, open-label, cluster-randomised trial. 37 practices (19 intervention) were recruited from the South-West and West Midlands regions of England. Practices were randomised to a complex intervention comprising a clinical informatics tool (designed to support medication review and case-finding), training and implementation of a four-stage structured medication review (pharmacist review of case-notes, inter-professional collaborative discussion between pharmacist and general practitioner (GP), review with the patient (by telephone or in-person), and follow-up if indicated). Patients with 5+ medications and triggering at least one ‘potentially inappropriate’ prescribing indicator were recruited per practice. Patients in the intervention arm were asked to complete a survey (online or paper) examining their experience of the review.

Findings

731 patient participants in intervention practices were invited to complete the survey (June 2022-May 2023) with 73% response rate. Median age was 72 years (IQR 78-65 years), and 48% of respondents were women. 68% of respondents reported that their review was carried out by a pharmacist, and 75% indicated that they were unfamiliar with the reviewer. Most reviews (79%) were carried out remotely via telephone; 80% of respondents reported they were happy with where the review took place.

Over half of patients (53%) reported the review led to a decision to change medications; 62% of those patients considered this a shared decision, with 76% satisfied with the changes made. Around half of patients agreed that reviewers helped them to understand all the information during the review (50%) and that the review led to agreement on how to proceed (52%), although around a quarter strongly disagreed that different treatment options were discussed.

Patients generally considered reviews to be patient-centred (78-85% rating clinicians as good on 4 components of CARE measure).

Overall, 75% were satisfied with their review; the odds of being satisfied were significantly associated (p<0.001) with increasing shared decision making (OR 2.32 [95% CI 2.01-2.67] per quintile increase in SDM-Q-9 score).

Consequences

Patients considered polypharmacy medication reviews conducted predominantly by telephone by a clinical pharmacist, to be acceptable and patient-centred, despite usually being unfamiliar with the clinician. Decision-making was perceived as shared, although there are opportunities to improve discussion of treatment options. The findings support current models of care delivery, although must be considered in the context of the IMPPP review being supported by appropriate training and informatics.