Implementing a medication review and deprescribing intervention for older people living with frailty and polypharmacy in general practice: a feasibility study
Implementing a medication review and deprescribing intervention for older people living with frailty and polypharmacy in general practice: a feasibility study
Background: polypharmacy in older adults with frailty increases risks of adverse outcomes. Evidence supports proactive structured medication reviews (SMRs) for medicines optimisation, including deprescribing, however challenges exist in general practice.
Aim: to test the implementation of a co-designed multidisciplinary SMR intervention (MODIFY) for this high-risk group.
Design & setting: a non-randomised pre-post feasibility study was conducted across five general practices in England. The multidisciplinary intervention comprised five components including patient and health care professional (HCP) preparation.
Method: patients aged ≥75 with moderate-to-severe frailty (eFI >0.25) and ≥5 medications were identified and invited to participate.
Primary outcomes were recruitment, retention, and completion of outcome measures. Secondary outcomes included medication-related outcomes, healthcare utilisation, adverse drug reactions, and acceptability to patients and HCPs based on qualitative interviews.
Results: of 479 patients invited, 48 were recruited (10% rate); 47 received the intervention, 43 completed three-month follow-up (92% retention). Medication changes occurred in 87% of participants; 72% had at least one medication stopped and 26% had a dose reduced. The mean number of medications decreased slightly by 0.27 (SD:1.44) without significant change in clinical and patient-reported outcomes (including function, frailty status, treatment burden) and no reported adverse events. Qualitative interviews with 10 patients, 1 carer, and 8 HCPs, indicated high acceptability and perceived value, and suggested improvements.Economic data was well completed. SMRs cost £28.50 per patient. Participants' reported quality of life improved slightly over three months.
Conclusion: the MODIFY intervention is feasible and acceptable for deprescribing in primary and support progression to a definitive trial.
Radcliffe, Eloise
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Kandala, Ngianga
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Sach, Tracey
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McCloskey, Sara
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Howard, Clare
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Sheikh, Claire
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Bradbury, Katherine
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Latter, Sue
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Recio Saucedo, Alejandra
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Lown, Mark
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Brad, Lawrence
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Fraser, Simon D.S.
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Ibrahim, Kinda
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Radcliffe, Eloise
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Kandala, Ngianga
07a8c745-6e54-4496-8e8e-bbc74d990886
Sach, Tracey
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McCloskey, Sara
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Howard, Clare
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Sheikh, Claire
eab31d73-d098-4dce-9d0c-3254f3db277c
Bradbury, Katherine
87fce0b9-d9c5-42b4-b041-bffeb4430863
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b
Recio Saucedo, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Lown, Mark
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Brad, Lawrence
ea3efe02-d916-4493-b93c-57819db4fc28
Fraser, Simon D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Ibrahim, Kinda
54f027ad-0599-4dd4-bdbf-b9307841a294
Radcliffe, Eloise, Kandala, Ngianga, Sach, Tracey, McCloskey, Sara, Howard, Clare, Sheikh, Claire, Bradbury, Katherine, Latter, Sue, Recio Saucedo, Alejandra, Lown, Mark, Brad, Lawrence, Fraser, Simon D.S. and Ibrahim, Kinda
(2026)
Implementing a medication review and deprescribing intervention for older people living with frailty and polypharmacy in general practice: a feasibility study.
BJGP Open.
(doi:10.3399/BJGPO.2025.0175).
Abstract
Background: polypharmacy in older adults with frailty increases risks of adverse outcomes. Evidence supports proactive structured medication reviews (SMRs) for medicines optimisation, including deprescribing, however challenges exist in general practice.
Aim: to test the implementation of a co-designed multidisciplinary SMR intervention (MODIFY) for this high-risk group.
Design & setting: a non-randomised pre-post feasibility study was conducted across five general practices in England. The multidisciplinary intervention comprised five components including patient and health care professional (HCP) preparation.
Method: patients aged ≥75 with moderate-to-severe frailty (eFI >0.25) and ≥5 medications were identified and invited to participate.
Primary outcomes were recruitment, retention, and completion of outcome measures. Secondary outcomes included medication-related outcomes, healthcare utilisation, adverse drug reactions, and acceptability to patients and HCPs based on qualitative interviews.
Results: of 479 patients invited, 48 were recruited (10% rate); 47 received the intervention, 43 completed three-month follow-up (92% retention). Medication changes occurred in 87% of participants; 72% had at least one medication stopped and 26% had a dose reduced. The mean number of medications decreased slightly by 0.27 (SD:1.44) without significant change in clinical and patient-reported outcomes (including function, frailty status, treatment burden) and no reported adverse events. Qualitative interviews with 10 patients, 1 carer, and 8 HCPs, indicated high acceptability and perceived value, and suggested improvements.Economic data was well completed. SMRs cost £28.50 per patient. Participants' reported quality of life improved slightly over three months.
Conclusion: the MODIFY intervention is feasible and acceptable for deprescribing in primary and support progression to a definitive trial.
Text
BJGPO.2025.0175.1.full
- Accepted Manuscript
More information
Accepted/In Press date: 2 February 2026
e-pub ahead of print date: 5 March 2026
Identifiers
Local EPrints ID: 511283
URI: http://eprints.soton.ac.uk/id/eprint/511283
ISSN: 2398-3795
PURE UUID: 7a3a564b-4241-4924-b0ab-b4339ff65078
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Date deposited: 11 May 2026 16:44
Last modified: 16 May 2026 02:19
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Contributors
Author:
Ngianga Kandala
Author:
Tracey Sach
Author:
Sara McCloskey
Author:
Clare Howard
Author:
Claire Sheikh
Author:
Lawrence Brad
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