Article Text
Abstract
Objectives To evaluate the feasibility and potential clinical benefits of medicines optimisation through comprehensive geriatric assessment (CGA) of frail patients with multiple conditions, by secondary care geriatricians in a general practice care setting.
Methods Seven general practitioner (GP) practices in one region of Stoke-on-Trent volunteered to take part. GPs selected patients (n=186) who were local permanent residents, at least 65 years old and on eight or more medications per day. Patients were sent a written invitation outlining the assessment purpose/format. Prior to patient assessments, primary care staff prepared packs detailing patient medical history, recent consultations, current medications, recent laboratory tests and social circumstances. One hour was allocated for the CGA per patient, with one of three geriatricians, to enable sufficient time to explore all relevant aspects. Assessment comprised a full history, thorough clinical examination, assessment of balance and mobility, mental function and information on home environment and support arrangements. After consultation, geriatricians made recommendations regarding further assessments, investigations or medication changes. Geriatricians entered their main findings and recommendations onto a standard template.
Results In total, 687 recommendations for changes in patients’ medication regimens were made for 169 (91%) patients. In 17 (9%) patients there was no recommendation to alter medications. This resulted in an average of four alterations in medication per patient. The predominant changes to medications were to stop medications (34%) or to reduce the dosage (24%). Starting a new medication represented 18% of all the medication changes. Adherence rates to geriatrician medication recommendations were 72% at 6 months and 65% at 12 months.
Conclusions CGA of older patients with complex needs, by geriatricians in a general practice care setting, is feasible. Our study demonstrated constructive collaboration between GPs and geriatricians from secondary care, suggesting further studies and clinical trials are feasible and have scope to yield beneficial outcomes.
- geriatrician
- multi-morbidity
- comprehensive geriatric assessment
- polypharmacy
- medicines optimisation
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Footnotes
Contributors SCL helped to manage the project, analysed the data and drafted and revised the paper. KLW co-managed the project and reviewed/revised the paper. NAD collected all data and contributed to the data analysis. BP was the lead geriatrician who undertook comprehensive geriatric assessments of patients and reviewed and revised the paper. MJB was the independent statistician and reviewed/revised the paper. AA reviewed the paper. RC devised, funded and comanaged the project as well as reviewed and revised the paper.
Funding This work was supported by Stoke-on-Trent Clinical Commissioning Group
Competing interests Sally-Ann Chambers, one of the geriatricians who undertook the comprehensive geriatric assessments, is the daughter-in-law of RC.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There is no additional unpublished data relevant to this work.