Team Approach to Polypharmacy Evaluation and Reduction

INTERVENTION: Participants in the intervention group will receive the The Team Approach to Polypharmacy Evaluation and Reduction (TAPER) intervention. TAPER is a structured pathway for a comprehensive medication review by the pharmacist and general practitioners (GPs) with input from the patient aimed at reducing medication burden. The ‘Team’ in this intervention model refers to the patient, pharmacist and GP. The focus is on maintaining essential drugs while supporting potential reduction in medicines that are: (i) having an adverse effect, (ii) risk outweighs benefit, (iii) medications that are no longer of benefit or reasons for talking them are unclear and (iv) potential medication benefit that is no longer aligned with goals of patient. TAPER uses a web‐based application (available at https://meds.tapermd.org) to facilitate the decision making process. TaperMD performs a ‘machine screen’ comprising a drug‐drug interaction checker and listing of potentially inappropriate medicines. TaperMD also provides links to existing evidence‐based tools providing Numbers Needed to Treat/Harm, decision aids for deprescribing and where available, and tapering guidelines. The key steps for TAPER are: 1. Study pharmacist consultation: The participant will be engaged in a medication‐focused interview with a study pharmacist. Information will be collected about medications taken, dosages, indications for medications and other mediation‐related information if available, any perceived or known medicine problems or side effects, prioritised functional and symptom goals for medical treatment, and overall preferences for care. This data will be entered directly into TaperMD. Through application of automated filters within the TaperMD program, a list potentially inapprop CONDITION: Polypharmacy; ; Polypharmacy Public Health ‐ Health service research PRIMARY OUTCOME: Change in the mean number of medications [medication reconciliation using the following sources ‐ participant‐reported, community pharmacy dispensing records and audit of GP electronic medical record][Baseline, 6 months and 12 months (primary timepoint)] INCLUSION CRITERIA: 1. Person aged 70 years or older 2. Taking 5 or more medicines 3. Regular patient at the participating GP practice 4. Living in community 5. Patient willing to consider discontinuation of some medications SECONDARY OUTCOME: Adverse events [participant‐reported and audit of GP electronic medical record][1 week, 3 months, 6 months and 12 months] Care level transitions [participant‐reported and audit of GP electronic medical record][1 week, 3 months, 6 months and 12 months] Cognition assessed using Modified Telephone Interview for Cognitive Status [Baseline, 6 months and 12 months] Composite outcome of healthcare resource utilisation comprising hospitalisations and emergency department attendances (planned and unplanned), care level transitions and primary care consultation [participant‐reported and audit of the GP electronic medical record][1 week, 3 months, 6 months and 12 months] Composite outcome of the mean number of medication discontinuations and dose reductions [medication reconciliation using the following sources ‐ participant‐reported, community pharmacy dispensing records and audit of GP electronic medical record][Baseline, 6 months and 12 months] Drug Burden Index ; [Baseline, 6 months and 12 months] Emergency Department attendances (p[anned) [participant‐reported and audit of GP electronic medical record][1 week, 3 months, 6 months and 12 months] Emergency Department attendances (unplanned) [participant‐reported and audit of GP electronic medical record][1 week, 3 months, 6 months and 12 months] Falls [participant‐reported and audit of GP electronic medical record][1 week, 3 months, 6 months and 12 months] Hospitalisations [participant‐reported and audit of GP electronic medical record][1 week, 3 months, 6 months and 12 months] Medication Regimen Complexity Index[Baseline, 6 months and 12 months] Potentially inappropriate medications assessed using the AGS 2019 Beers Criteria[Baseline, 6 months and 12 months] Primary care consultation [participant‐reported and audit of the GP electronic medical record][1 week, 3 months, 6 months and 12 months] Quality of life assessed using EQ‐5D‐5L and Short Form 12[Baseline, 6 months and 12 months] Serious adverse drug withdrawal events [participant‐reported and audit of GP electronic medical record][1 week, 3 months, 6 months and 12 months] The mean number of dose reductions [medication reconciliation using the following sources ‐ participant‐reported, community pharmacy dispensing records and audit of GP electronic medical record][Baseline, 6 months and 12 months] The mean number of medication discontinuations [medication reconciliation using the following sources ‐ participant‐reported, community pharmacy dispensing records and audit of GP electronic medical record][Baseline, 6 months and 12 months]