National Roll-out Of The Goal-directed Medication Review Electronic Decision Support System (g-medss)© In Practice: A Longitudinal Study

• By: KOULADJIAN O'DONNELL, Lisa (The University Of Sydney, Australia)
• Co-author(s): Dr Lisa Kouladjian O'donnell (Departments of Clinical Pharmacology and Ageing, Kolling Institute, Faculty of Medicine and Health, The University Of Sydney and Northern Sydney Local Health District, Sydney, Australia)
  Ms Rayan Nahas (Departments of Clinical Pharmacology and Ageing, Kolling Institute, Faculty of Medicine and Health, The University Of Sydney and Northern Sydney Local Health District, Sydney, Australia)
  Dr Mouna Sawan (School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  Associate Professor Danijela Gnjidic (School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  Professor Sarah Hilmer (School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia)
  
• Abstract:

  Background information: The Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© provides guidance for healthcare practitioners conducting comprehensive medication reviews, to tailor care to meet their patients’ goals and preferences. G-MEDSS consists of The Goals of Care Management Tool (GCMT), The Drug Burden Index (DBI) Calculator© (a measure of anticholinergic and sedative medication burden), and the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire.(1) A recent implementation study of G-MEDSS within medication reviews did not reduce patients’ DBI at 3 months compared with usual care, but medication review recommendations to reduce DBI were significantly greater in the intervention group.(2)
  Hypothesis: To understand the factors that influence the implementation of deprescribing anticholinergic and sedative medications using G-MEDSS, a national roll-out will identify users and settings where G-MEDSS can be implemented. Purpose: This study aimed to describe the 1) users of G-MEDSS; 2) clinical settings where G-MEDSS was used; and 3) patients for whom G-MEDSS was used; during a national longitudinal implementation study.
  Method: Prospective evaluation (period: 1st May 2020 – 19th April 2023). The study was advertised to Australian registered medical practitioners, pharmacists and nurses through relevant professional organisations, and through a national anticholinergic burden campaign delivered by NPS MedicineWise (October 2021 – June 2022)(3). Participants were invited to register to use G-MEDSS within their clinical practice settings. De-identified data about the users and their patients were collected through the website and descriptively analysed.
  Results: A total of 544 participants (374 pharmacists, 133 medical practitioners and 37 nurses) registered to use G-MEDSS, with most participants from New South Wales (n=173,31.8%). The median (IQR) number of patients for whom G-MEDSS was used per participant was 2(3). These participants used G-MEDSS for 974 patients (mean age(SD) 75.3(15.0)), predominately during medication reviews in the home and residential aged care (n=419, 43.0% and n=402, 41.3%, respectively). The 5269 medication recommendations made by G-MEDSS users consisted of 3817 (72.5%) for no change, 1199 (22.8%) to deprescribe the medication, 49 (0.9%) to increase the dose, and 94(1.8%) for general practitioner or pharmacist review.
  Conclusion: G-MEDSS is being used within clinical practice primarily by pharmacists to support medication review in the home and residential aged care. Future research may identify factors preventing G-MEDSS to be used more frequently and how to better integrate G-MEDSS within usual care.
  (1) G-MEDSS: https://gmedss.com/
  (2) Kouladjian O’Donnell L et al. Br J Clin Pharmacol 2021;87:1499-1511.
  (3) Anticholinergic burden: the unintended consequences for older people. https://www.nps.org.au/professionals/anticholinergic-burden