Optimising communication with general practitioners to sustain deprescribing decisions in hospital

Polypharmacy is increasing, especially in older adults, and one in five medicines taken by older adults is harmful or unnecessary (inappropriate). Approximately 90% of older adults would like to have a medicine withdrawn. Supervised withdrawal of inappropriate medicines (deprescribing) is safe and may improve quality-of-life in older people. Inappropriate medicines are a major burden to older adults and the health system and represent low value care.
Reviewing and reducing inappropriate polypharmacy is highlighted in several RACP EVOLVE lists, including those from ASCEPT, ANZSGM, IMSANZ and ANZSPM. Communication of decisions made in hospitals to withdraw medicines with general practitioners (GPs) and consumers is essential for continuity of care.
Objective
To design communication pathways that facilitate (in-hospital) medication review and deprescribing in high risk polypharmacy patients. This is part of a larger study to design clinical decision support tools to reduce inappropriate polypharmacy in older inpatients. GPs were recruited through the Northern Sydney Primary Health Care Network. Semi-structured interviews and focus groups were conducted with GPs to explore views of medicine review processes, polypharmacy, deprescribing, and future decision support.
Analysis
General inductive approach was used to identify themes.
Outcomes
Findings showed GPs were receptive to hospital clinicians contacting them about complex older patients, who were frail, on many medicines, or had multiple comorbidities. GPs preferred communication by phone during hospitalisation, and in writing at discharge. They wanted discharge instructions to be written in clear, concise, relevant, and simple language, to support discussion between consumers and GPs, and their preferred phrasing was elicited. GPs emphasised the importance of providing rationales for changes made to medicines in the
discharge letter. They described a number of perceived enablers and barriers to sustain deprescribing initiated in hospital such GP autonomy and strong patient-GP relationships, and communication between hospital pharmacists and GPs, and patient agency.