Improving Medicines use in People with Polypharmacy in Primary Care

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Polypharmacy (prescribing multiple medicines to one individual) is widespread and growing in the UK; ~6% of adults take 10+ regular medicines. Although often clinically appropriate, polypharmacy may be problematic leading to a range of adverse outcomes. Despite recent national guidance, there is a lack of evidence for medication optimisation interventions that improve outcomes. The aim of this project is to develop and evaluate an intervention to optimise medication use for patients with polypharmacy in a general practice setting.

The IMPPP intervention will be based in general practice involving GPs and pharmacists working together, drawing on the specific skills of each professional sensitive to the context of each practice. The intervention will comprise two key elements: (1) a model for conducting polypharmacy medication reviews (including pharmacist-GP collaboration and case finding) and (2) components to enhance professional engagement (education, practice feedback, financial incentives). These two key elements will be supported by an informatics tool integrated into practice clinical systems.

Chief Investigator:

Dr Rupert Payne

(University of Bristol)

Associate Investigator:

Dr Rupert Payne

(University of Bristol)

Study Coordinator: Zoe Johnson 
Sponsor / Reference Number:

University of Dundee / 2018PS03

University of Bristol / 2018-2188
Funder / Reference Number: NIHR Health Services and Delivery Research Programme / 16/118/14
UKCRN Study Portfolio Reference Number: 41260
Registration Reference Number:


Start Date: 01 Feb 2019
End Date:  30 Apr 2022

Study design

A multicentre cluster-RCT comparing intervention vs. usual care. The primary outcome is the mean number of Potentially Inappropriate Prescribing (PIP) indicators triggered per patient. Secondary outcomes include quality of life, health service use and treatment burden. A cost-effectiveness analysis will be conducted.

A parallel mixed-methods process evaluation will be undertaken examining implementation to help explain the success or otherwise of the intervention, and to inform subsequent implementation in practice.

Aim and objectives

This study will establish whether and how the IMPPP intervention is effective and cost-effective. It will provide valuable insights into how to best implement case-finding and prioritisation for review in patients with polypharmacy, how GPs and pharmacists can best collaborate to meet patients’ needs, and the role of informatics in supporting case-finding and focused review. If effective, the IMPPP intervention has the potential to improve health-related quality of life, improve prescribing and reduce adverse medication effects and treatment burden in a growing and highly vulnerable population.