Gold Coast Complex Care Project

Activity: Talk or presentationOral presentation


Disease management guidelines are poorly targeted for elderly patient with multiple long-term medical conditions. Elderly patients remain at high risk of hospital admission related to medication use1 but in general practice there is no systematic consideration of deprescribing opportunities.

We aimed to systematically address deprescribing, monitoring, preventative activities and planning for end-of-life care in elderly multi-morbid patients attending Australian general practice.

Over 75-year-old patients at high risk of hospital admission were identified from data extracted from four general practice clinics. We developed a multifaceted intervention to identify personal priorities and to address the needs of these patients using a care planning process.

Patients were invited to a planned series of quarterly appointments over a 12-month period to address deprescribing opportunities in line with patient-identified values.

Patients were assisted to identify their priorities and values. A multimorbidity care plan template was developed. Medication burden, quality of life, patient experience of care and unplanned hospital attendance were measured. GPs, practice managers and practice nurses provided qualitative feedback.

A systematic approach to multimorbid elderly patients is necessary and feasible within current Australian general practice.

1. Phillips et al. Hospital admissions caused by adverse drug events: an Australian prospective study. Australian Health Review; 2013
Period1 Dec 2018
Event title5th Annual Australian Deprescribing Network (ADeN) Annual Meeting 2018
Event typeConference
LocationAdelaide, AustraliaShow on map
Degree of RecognitionNational