ESCP International Workshop Extended responsibilities
for pharmacists in the treatment of acute and chronic
conditions, 15–16 June 2017, Leiden, The Netherlands
Published online: 13 July 2017
Ó Springer International Publishing AG 2017
Impact of deprescribing as part of clinical medication review
on polypharmacy of older patients in an integrated primary care
, Bram J. Mertens
, Marcel L. Bouvy
SIR Institute for Pharmacy Practice and Policy, Leiden.
Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute
for Pharmaceutical Sciences, Utrecht, Netherlands
Background and objective Deprescribing is the process of inten-
tionally stopping drugs or reducing its dose to improve the person’s
health or reduce the risk of adverse side effects. The objective of this
study was to examine the effect of deprescribing as part of clinical
medication review on polypharmacy for older patients in an inte-
grated primary care setting.
Setting and method Cross-sectional study. Patients C70 years and
using C7 drugs were recruited from two GP practices. Two com-
munity pharmacists in a non-dispensing role invited patients to the GP
practice or visited patients at home for an interview. The interview
was focused on health-related goals including patient’s complaints
possible due to adverse effects. Recommendations for medication
changes were discussed in a face-to-face meeting with the patient’s
GP and implemented in shared-decision making with the patient.
Main outcome measures Implemented recommendations for dis-
continuation of drugs and dose reduction; type of drug-related
Results 129 of 366 recommendations (35%) for 89 patients were
aimed at the discontinuation of drugs of which 57% were imple-
mented. 59 recommendations (16%) were aimed at dose reduction of
which 54% were implemented. The most prevalent drug classes
recommended for discontinuation were proton pump inhibitors (17),
calcium antagonists (10) and beta-blockers (6). The most prevalent
types of DRPs (mean 4.1 per patient) were ‘‘Overtreatment’’ (27%)
followed by ‘‘Potential adverse effect’’ (19%) and ‘‘Undertreatment’’
Conclusion Deprescribing as part of clinical medication review
within an integrated primary care setting can lead to a reduction in
Effect of pharmacist-led interventions on motor symptoms
and quality of life in Parkinson’s patients: a pilot study
, Fatma Karapinar
, Bart van den Bemt
Teus van Laar
Centre of Excellence on Parkinson’s Disease.
Neurology, University Medical Centre Groningen, Groningen.
Department of Hospital Pharmacy, Onze Lieve Vrouwe Gasthuis,
Department of Pharmacy, Maartenskliniek, Nijmegen,
Background and objective Patients with Parkinson’s disease (PD)
use many drugs, up to seven times a day. Non-motor symptoms give
rise to an even higher pill burden. However, despite the importance of
medication in Parkinson therapy, patients with PD are often non-
adherent to their medication and drug related problems occur fre-
quently. Therefore, the objective was to improve on–off symptoms in
ambulatory PD patients with a multi-faceted intervention program.
Setting and method A prospective pilot study was performed in an
outpatient clinic, where usual care was compared with stepwise
introduction of interventions. Each patient served as his own control.
The intervention program consisted of the introduction of automatic
dispensed unit dose (UDP) per time, a Parkinson Kinetic Graph
(PKG): an accelerometer with and without alarm-system for levo-
dopa-intake and a pharmacist-led medication review (MR).
Main outcome measures The study analysed endpoints at 6 weeks
(stage 1: usual care), 10 weeks (stage 2: UDP), 14 weeks (stage 3:
UDP + PKG alarm) and 26 weeks (UDP + PKG reports and alarm +
MR interventions)after inclusion, on motor-symptoms andQoL(PDQ-8).
Results On-time (objectiﬁed with patient diary) increased signiﬁ-
cantly from 54% (±30) at stage 1, to 64% (±25) at stage 3 to 68%
(±27) at stage 4. This equals a 1.8 respectively 2.5 h increase in on-
time in stage 3 resp. 4. Off- and dyskinesia time declined with 12
resp. 10% in stage 4.
A signiﬁcant difference in PDQ8 score was reached in stage 4 as
compared to stage 3 (mean 21.0 ± 3.5 and 19.5 ± 5.3 p = 0.01).
Conclusion Our data support the effectiveness of a clinical pharma-
cist at the outpatient clinic, to optimise clinical symptoms in PD
patients. Further analysis is needed to determine effects of these type
of interventions on non-motor symptoms.
Int J Clin Pharm (2017) 39:969–976