A Retrospective Cohort Study of structured medication review in rural primary care patients with geriatric polypharmacy

Erik Lindqvist; A. Nilsson; S. Andersen

doi:10.5281/zenodo.22813707

Authors

Erik Lindqvist Division of Primary Care Research, Guadalquivir Institute of General and Internal Medicine Author https://orcid.org/4996-3659-9388-9868
A. Nilsson Department of General and Internal Medicine, Po Academy of General and Internal Medicine Author https://orcid.org/0083-1038-8053-9760
S. Andersen Department of General and Internal Medicine, Fraser Academy of General and Internal Medicine Author https://orcid.org/0181-2316-0612-6057

DOI:

https://doi.org/10.5281/zenodo.22813707

Keywords:

Polypharmacy, Medication review, Deprescribing, Rural primary care, Geriatrics

Abstract

Graphical abstract

Geriatric polypharmacy is common in rural primary care, where fragmented specialist prescribing and limited on-site pharmacy support raise the risk of potentially inappropriate medications (PIMs) and adverse outcomes. We conducted a retrospective cohort study across eleven rural primary care practices, comparing patients aged 65 years or older with ten or more concurrent medications who received a structured medication review (n=284) against a propensity-matched usual-care comparison group (n=284). At 12 months, the review group's mean PIM count fell from 3.8 to 1.9, a significantly greater reduction than the 0.4 seen with usual care (adjusted difference-in-differences 1.5, 95% CI 1.2-1.8, p<0.001), and 61.6% achieved a sustained deprescribing event versus 18.7% with usual care. The review group also showed lower emergency department visits, unplanned admissions, and falls or fractures. Structured medication review delivered within rural primary care workflows, without dedicated on-site clinical pharmacy staffing, was associated with substantial reductions in inappropriate prescribing burden and favorable utilization outcomes, supporting wider adoption pending prospective confirmation.

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