Less Medicines in Older Patients in the Netherlands, The Lemon Study: Study Protocol of a Cluster Randomised Controlled Trial

Background and Objective: Overtreatment with cardiometabolic medication is a common phenomenon in older patients. Up to 20% of these patients may be eligible for deprescribing. Deprescribing may decrease the risk of adverse drug events and is indicated when a drug may lead to more harm than benefits. The LeMON study aims to develop, implement and evaluate a standardized template for the performance of clinical medication reviews (CMR) using evidence based tools and training to support deprescribing of cardiometabolic medication. Method: A clustered randomized controlled study involving twenty community pharmacists (CP). CP will be asked to conduct a CMR in ten patients. The intervention group will receive training on the background of deprescribing cardiometabolic medication and the use of tools and the control group will perform a CMR according to standard practice. Follow-up will take place within four weeks (T1) and after three months (T2) following the CMR. Patients 70 years or older; polypharmacy and chronic use of at least one blood pressure medicine and having a systolic blood pressure below 140 mmHg, or chronic use of glucose lowering medication and HbA1c level below 54 mmol/ mol were included. Discussion: The LeMON study will assess whether a primary care-based intervention educating CPs about deprescribing cardiometabolic medication reduces the number of cardiometabolic medication used by older patients with a blood pressure or HbA1c lower than the treatment targets tment. The use of algorithms including information on blood pressure and/or HbA1c and cardiometabolic medication use has not been studied previously.