LAUSR

AIMS To provide post-hoc analyses of a clinical trial that reported beneficial effects of medication reviews on health-related quality of life. Specifically, to describe the medication changes with a focus on deprescribing, and to explore patient- and medication-related factors that may identify patients most likely to benefit from medication reviews. METHODS Post-hoc analyses of data from a pragmatic, non-blinded, randomized clinical trial investigating a medication review intervention (NCT03911934) in 408 geriatric outpatients treated with ≥9 medicines. RESULTS In the medication review group (n=196), 26% of the medicines prescribed at baseline were discontinued with 82% still being discontinued after 13 months. The most common reason for discontinuation was lack of indication (72% of discontinuations). The medicines most often discontinued in the medication review group compared with usual care included: metoclopramide (11/15=73% discontinued vs 1/12=8% in usual care), acetylsalicylic acid (20/48=42% vs 2/47=4%), simvastatin (18/48=38% vs 2/58=3%), zopiclone (23/59=39% vs 4/54=7%), quinine (9/14=64% vs 6/16=38%), citalopram (4/18=22% vs 0/20=0%), and tramadol (18/37=49% vs 8/30=27%). Factors associated with number of deprescribed medicines included: number of prescribed medicines, Drug Burden Index, patient motivation for medicine changes, and prescriptions of metoclopramide, iron preparations, antidepressants other than SSRIs, NSAIDs, or drugs for urinary incontinence. CONCLUSION Physician-led medication reviews resulted in persistent deprescribing of medicines in older polypharmacy patients treated with ≥9 medicines. Motivation for having their medicine changed, treatment with more medicines, and a higher burden of sedative and anticholinergic medicines characterized the patients most likely to benefit from physician-led medication reviews.