PUB - Publikationen an der Universität Bielefeld

Background and Objective: Although polypharmacy is not inappropriate per se, it increases the risk of adverse drug reactions (ADRs), especially in older patients. The aim of the PARTNER cluster-randomised trial is to evaluate the effectiveness, cost-effectiveness and implementation of a patient-centred structured care pathway of general practitioner (GP)-pharmacist collaboration in German primary care, focused on deprescribing of psychotropic and anticholinergic drugs. Method: The study design is a multicentre, two-arm cluster-randomised trial accompanied by a health economic and process evaluation. Clusters consist of one GP practice and one or more collaborating community pharmacies, which are randomly assigned to either the PARTNER intervention group or a control group. At least 45 GP practices will enroll a total of 352 patients (≥ 65 years with polypharmacy and use of ≥ 1 psychotropic/anticholinergic drugs) across three study sites, starting in October 2022. In the PARTNER intervention arm, intervention components comprise (A) educational material for GPs and pharmacists on psychotropic/anticholinergic deprescribing, (B) a moderated interprofessional workshop, (C) patient empowerment via a pre-planned patient-pharmacist consultation facilitated by empowerment leaflets, and (D) shared decision making as part of a pre-planned patient-GP consultation. The only intervention component in the PARTNER control arm is a pre-planned patient-pharmacist consultation to update medication plans and conduct a medication safety check with no particular focus on psychotropic/anticholinergic drugs. Main outcome measures: The primary endpoint of the study is a patient level reduction in psychotropic/anticholinergic exposure, reflected by a reduction of 0.15 points or more on the Drug Burden Index. Secondary endpoints examine the effect of the intervention on prevalent vs incident use of target drugs, on clinical symptoms and on patient-reported outcomes. Results: This cluster-randomised trial will establish whether the PARTNER intervention can reduce the use of psychotropic/anticholinergic drugs in older people, its benefit-risk ratio as well as barriers and facilitators to its implementation. Conclusion: Infrastructural and political developments offer new opportunities for intensified collaboration between GPs and pharmacies in German primary care. The PARTNER project provides insights into whether broad implementation of the PARTNER intervention is effective, efficient, and appropriate, but also how collaboration between GPs and pharmacies can succeed in order to increase patient safety.