Discussion
SECONDARY, RECURRENCE
In this pragmatic cluster randomized clinical trial, family conferences led by GPs in primary care were promoted to facilitate deprescribing and shared prioritization in community-dwelling older adults with frailty taking 5 or more medications. There were no significant differences between the intervention and control groups in the number of hospitalizations after 12 months as a measure of patient safety. This is in line with a number of other deprescribing studies in older adults with polypharmacy that have noted no positive impact on hospital admissions or other clinical outcomes.Regarding the secondary outcomes of our study, there was no significant difference between the intervention and control group in the number of medications taken per patient and in the number of EU(7)-PIM drugs according to the EU(7)-PIM list after 12 months in the PP population. These results are in line with many studies on deprescribing, which showed that even a reduction in medication in the first step (before clinical end points are realized in the second step) is not easy to achieve.However, the initial significance of changes in medication at 6 months, followed by nonsignificant changes at 12 months, suggests that it is difficult to sustain efforts to reduce medication use over time. Possible reasons for the convergence of prescription rates at 12 months for the most relevant drugs in our study (EU[7]-PIMs, proton pump inhibitors, urate-lowering medications, statins, oral antidiabetics) could be a recurrence of clinical problems that originally led to the prescription, represcribing of the medication by other medical specialists, and new clinical problems.