A Physician-Pharmacist Partnership Intervention for Deprescribing (P3iD) among Older Adults Attending a Falls and Syncope Clinic: Protocol for a Randomised Controlled Trial

Participants in the intervention group will receive an in-depth medication review of approximately 30 minutes performed by a pharmacist, which will focus on identifying PIMs as opportunities for deprescribing. In the intervention group, PIMs identified will be deprescribed using the P3ID intervention. P3ID intervention consists of 5 steps: Step 1: PIM identification a) Participant selection Researcher reviews electronic medical record (EMR) before follow-up to obtain medication list and identify any potentially inappropriate medications (PIMs). The researcher will then contact selected potential participants, asking them to arrive an hour before their scheduled appointment at the clinic and reminding them to bring their medications for review. b) Medication review The participant completes the written consent form and a baseline demographic questionnaire, Patients were then asked to complete the Patient Medication Adherence Instrument (PMAI-9), a self-reported measure designed to assess medication adherence from the patient's perspective. The pharmacist conducts a medication review using the STOPPFall criteria to identify PIMs and asks about any medication-related issues and self-monitoring practices (e.g., blood pressure or glucose levels). The pharmacist then completes the Healthcare professional-Medication Adherence Instrument (HMAI-9), a self-reported tool designed to evaluate medication adherence from the healthcare professional's perspective. Step 2: Decisions on prioritization on cessation Algorithm for deciding order and mode in which drug use could be discontinued will be applied to determine deprescribing strategy. Step 3: Medication withdrawal a) Physician-pharmacist discussion Pharmacist discusses deprescribing opportunities with physician. b) Doctor-patient consultation If physicians decides to deprescribe, discussion is held with patients Step 4: Monitoring and support a) Doctor’s feedback to the pharmacist Physician will inform the pharmacist of patients’ latest medication regimen b) Medication counselling Pharmacist counsel patients and reinforce instructions given by physician. Step 5: Documentation Physician documents consultation and shared decision at EMR