Efficacy of implementation of the Goal-directed Medication review Electronic Decision Support System (G-MEDSS) into Home Medicines Review (HMR) to deprescribe medications in older adults

The Goal-directed Medication review Electronic Decision Support System (G-MEDSS) (accessible from gmedss.com) is a validated electronic platform that has been designed to provide clinical decision support for healthcare practitioners when completing a medication review for their older patients, to tailor care to meet their goals and preferences. The G-MEDSS is designed to produce patient-specific deprescribing reports for a patient’s GP. The G-MEDSS contains three tools: 1) The Goals of Care Management tool allows the patient’s goals of care to be identified and aligned with their medication strategies. 2) The Drug Burden Index Calculator© is a validated tool that identifies medications with anticholinergic and sedative effects (measured by the DBI) and provides information and recommendations for physicians. 3) The revised Patient’s Attitudes Towards Deprescribing questionnaire (rPATD) was developed and validated to explore people’s attitudes, beliefs, and experiences regarding the number of medications that they are taking, and how they would feel about cessation of one or more of their medications. The G-MEDSS deprescribing report for an individual patient includes the patient’s global goal of care, a summary of the patient’s current medications, the patient’s DBI score and information about interpreting the DBI, information about the rPATD, and a summary of the patient’s responses to the rPATD. The G-MEDSS system also allows accredited pharmacists to enter medication recommendations and actions on the G-MEDSS reports to allow for the GP to comment on deprescribing recommendations. The G-MEDSS system also allows for a patient summary report (or carer’s summary report) to be produced that can be provided to patients or carers at the time of the Home Medicines Review (HMR). Accredited pharmacists are specially trained pharmacists who are able to conduct medication management reviews (such as a HMR) for patients, under the referral of a general practitioner. Accredited Pharmacists are usually registered with the Australian Association of Consultant Pharmacy or the Society of Hospital Pharmacy. The HMR service is an Australian government-funded community-based collaborative service between the patient, general practitioner (GP) and accredited pharmacist. As part of the service, an accredited pharmacist receives a referral for a patient from the GP (either directly or through the patient’s community pharmacy), conducts an interview with the patient (usually in the home) to gain a comprehensive medication profile, and documents medication review findings and recommendations in a report for the GP, which can then be used to formulate the patient’s medication management plan. Accredited Pharmacists in the intervention group in this study will produce G-MEDSS reports for their HMR patients to send together with the HMR report to the patient’s GP. This will be done once at baseline.