JMIR Publications

ABSTRACT

Background:

The inappropriate use of multiple medications, known as polypharmacy, is a growing concern for the elderly population in India, who are often prescribed multiple medications due to comorbid conditions. This can lead to serious adverse health outcomes, increased healthcare costs, and reduced quality of life. Screening tools, such as the Medication Appropriateness Index (MAI) and the STOPP/START criteria, can help identify potentially inappropriate medications (PIMs), and interventions, such as medication review clinics and prescribing audits, can help improve appropriateness. Collaborative medication review (CMR) involving a team approach is important to ensure that patients receive the best possible care. However, the cost of these interventions remains a concern, especially in countries where healthcare spending is high for the elderly population.

Objective:

This study aims to assess the feasibility of implementation of inter-departmental Collaborative Medication Review (CMR) to reduce potentially inappropriate medications (PIMs) in the hospitalised elderly patients and to determine the costs involved in the implementation of inter-departmental CMR from health system perspective.

Methods:

The study comprises five phases aimed at improving Collaborative Medication Review (CMR) practices in India. Phase 1 focuses on conducting a scoping review of CMR practices. Phase 2 involves creating Standard Operating Procedures (SOPs) to establish a CMR team, delineating roles and responsibilities, and providing training. Phase 3 will evaluate the efficacy of CMR using standardized tools like the Medication Appropriateness Index (MAI) and STOPP/START criteria. Phase 4 assesses the challenges faced in implementing CMR in Indian healthcare. Finally, Phase 5 analyses the costs related to CMR implementation from a health system perspective. The study employs a multicentered mixed-method approach, combining qualitative methods (in-depth interviews and focus group discussions) to explore implementation challenges, and quantitative analysis through a quasi-experimental study involving 280 hospitalized elderly patients. It aims to measure costs and the reduction of potentially inappropriate medications (PIMs) post-discharge. A comprehensive Case Record Form will document both direct and indirect costs associated with the CMR process, enabling a thorough economic evaluation.

Results:

The study received a grant from the Indian Council of Medical Research–Safe and Rational Use of Medicine Task Force (ICMR-SRUM Task Force) in December 2023. This is a study protocol and does not contain any study data to publish as results.

Conclusions:

The findings of this study provide valuable insights into the implementation and effectiveness of CMR in the Indian healthcare setting. This study helps to understand the facilitators of and barriers to implementing interdepartmental collaborative medication review (CMR) and the cost incurred in its implementation from a healthcare provider perspective in an Indian healthcare setting. Healthcare professionals from different departments or disciplines work together to review the medication needs of elderly patients, who more commonly suffer from multiple chronic conditions. This approach addresses the challenges of managing multimorbidity in India, such as professional isolation, inadequate guidelines and evidence-based medicine, and barriers pertaining to shared decision-making by treating clinicians. The collaborative medication review process allows for a more comprehensive and coordinated approach to medication management, potentially improving patient outcomes and reducing healthcare costs. Clinical Trial: The study has been registered with the Clinical Trials Registry–India (CTRI/2024/06/069220) registered on 19/06/2024.