Aim: To measure the prevalence of polypharmacy and describe the prescribing of potentially inappropriate medication (PIM) in older people with polypharmacy in primary care. Methods: A multi-country retrospective cohort study across six countries: Belgium, France, Germany, Italy, Spain, UK. We used anonymized longitudinal patient level information from general practice databases hosted by IQVIA. Patients ≥65 years were included. Polypharmacy was defined as having 5-9, and ≥10 distinct drug classes (ATC Level 3) prescribed during a 6-month period. PIM defined: opioids, antipsychotics, proton pump inhibitors (PPI), benzodiazepines (ATC Level 5). We included country experts on the health care context to interpret findings. Results: Age and gender distribution was similar across the six countries (mean age 75-76 years; 54-56% female). The prevalence of polypharmacy of 5-9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany). In the polypharmacy population prescribed ≥5 drugs, opioid prescribing ranged from 11.5% (France) to 27.5% (Spain). Prescribing of PPI was highest with almost half of patients receiving a PPI, 42.3% (Germany) to 65.5% (Spain). Benzodiazepine prescribing showed a marked variation between countries, 2.7% (UK) to 34.9% (Spain). The health care context information explained possible underreporting for PIM. Conclusion: We have found a high prevalence of polypharmacy with more than half of the older population being prescribed ≥5 drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, worrying high usage of PIM (PPIs and benzodiazepines) supports current efforts to improve polypharmacy management across Europe.

Background: A quasi-experimental study investigated a pharmacist-led intervention aimed at deprescribing among patients with type 2 diabetes at risk of hypoglycaemia. Objective: To evaluate the process of implementing the intervention in primary care in order to understand variations in implementation and outcomes. Methods: Mixed-methods study based on the Grant-framework, with 10 domains, including recruitment of patients, delivery of the intervention, and response of pharmacists and patients. Data collected were: administrative logs, semi-structured observations of patient consultations (n=8), interviews with pharmacists (n=16), and patient-reported experience measure (PREM) questionnaires (n=66; response 73%). Results: Ninety patients from 14 pharmacies were included. Although the selection of patients based on high hypoglycaemia-risk was considered useful, pharmacists experienced barriers to proposing deprescribing in patients with recent medication changes, patients without current health problems or hypoglycaemic events, and patients treated in secondary care. The consultation aid and deprescribing tool provided were evaluated positively by the pharmacists. The majority of patients were satisfied with the service and information that the pharmacists provided. Conclusion: Pharmacists and patients were positive about the intervention. Both groups valued the consultation on deprescribing, supported by tools. To optimise the effect, improvements can be made to patient selection and local agreements on proactive deprescribing.

Aims. To provide an overview of the types of interventions performed by community pharmacists and describe their effects on patients with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). Methods. This review was conducted according to the PRISMA-Scr guidelines. PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for (non-) randomized controlled, before-after, and interrupted time series design. There was no restriction in the publication language. Included interventions had to be delivered by community pharmacists in primary care and community settings. The study quality was assessed using the National Institute of Health tools. Results were analyzed descriptively. Results. Twenty-eight studies were included representing 4,434 patients (mean age from 47.4 to 59.5 years, 55.4% female). Four studies were single- and the remaining studies were multiple-component interventions. Face-to-face counseling of patients was the most common intervention, often combined with providing printed materials, remote consultations, or conducting medication reviews. Generally, studies showed improved outcomes in the intervention group, including clinical, patient-reported and medication safety outcomes. In most studies at least one domain was judged to be of poor quality, with heterogeneity among studies. Conclusions. Community pharmacist-led interventions among T2DM patients showed positive effects in LMICs, but the quality of the evidence was poor. Face-to-face counseling of varying intensity, often combined with other strategies, was the most common type of intervention. Although these findings support the expansion of the role of the community pharmacist in diabetes care in LMICs, better quality studies are needed to evaluate further impact.

Objectives. The aim of this systematic review is to assess the effects of community pharmacist-led interventions to optimize the use of antibiotics and identify which interventions are most effective. Methods. This review was conducted according to the PRISMA-P guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context and be pharmacist-led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient reported outcomes. Risk of bias was assessed using the ‘Cochrane suggested risk of bias criteria’ and narrative synthesis of primary outcomes conducted. Results. Seventeen studies were included covering in total 3,822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, twelve on secondary outcomes and two on both. Three studies reported improvements in quality of dispensing where interventions led to more intensive symptom assessment and a reduction of OTC or wrong choice antibiotic supply. Some interventions led to higher consumer satisfaction, effects on adherence were mixed. All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies. Conclusions. Our review suggests some possible positive results from pharmacist-led interventions, but the role of the pharmacist needs to be expanded. This review should be interpreted as exploratory research, as more high-quality research is needed. Authors did not receive funding for the review.

Objective Polypharmacy is common in people with diabetes and associated with the use of potentially inappropriate medication (PIM). This study aimed to assess trends in prevalence of polypharmacy and PIM in older and middle-aged people with diabetes. Methods A repeated cross-sectional study using the University Groningen IADB.nl prescription database was conducted. All people ≥45 years treated for diabetes registered in the period 2012-2016 were included. PIMs were assessed using Beers criteria for people ≥65 years old, and PRescribing Optimally in Middle-aged People’s Treatments (PROMPT) criteria for 45-64 years old. Chi-square tests and regression analysis were applied. Results The prevalence of polypharmacy increased from 56.5% to 58.2% during the study period. In 2016, the prevalence of polypharmacy was 36.9% in the group of 45-54 years old, 50.3% in 55-64 years old, and 66.2% in ≥65 years old. All age-groups showed significant increases. The prevalence of older people with at least one PIM decreased around 3%, while in the middle-aged group this prevalence increased around 1% with a highest level in 2015. The most common PIMs in both age groups were the use of long-term high-dose proton-pump-inhibitors, benzodiazepines, and strong opioids without laxatives. Of those, only benzodiazepines showed a decreasing trend. Conclusions Polypharmacy increased in older and middle-aged people with diabetes. While the prevalence of PIM decreased over time in older age, this trend was not observed in middle-aged people with diabetes. Efforts are needed to decrease the use of PIMs in populations already burdened with many drugs, notably at middle age