IMPLEMENTATION AND EVALUATION OF A TEAM APPROACH TO POLYPHARMACY EVALUATION AND REDUCTION (TAPER) AMONG ADULTS WITH CHRONIC KIDNEY DISEASE IN CANADIAN PRIMARY CARE

Polypharmacy is a growing public health concern affecting around 40% of older adults. Patients with chronic kidney disease (CKD) are vulnerable to polypharmacy as they require multiple medications to manage CKD progression, its complications and associated comorbidities. Polypharmacy is associated with adverse health outcomes including falls, cognitive impairment, medication non-adherence, and mortality. Despite clinical practice guidelines, potentially inappropriate medication (PIM) use remains common. Given that many CKD patients are managed in primary care, effective interventions are urgently needed to support primary care physicians in identifying and reducing inappropriate polypharmacy while maintaining evidence-based care for patients with CKD and multimorbidity. The Team Approach to Polypharmacy Evaluation and Reduction (TAPER) is an effective, evidence-based, structured clinical pathway integrated into a web-based platform (TaperMD) aimed at reducing inappropriate polypharmacy. It addresses common barriers to deprescribing through multidisciplinary medication review, patient-centered goal setting, and automated screening for PIMs (including CKD-specific PIMs) and cumulative medication burden. Below, we outline a multi-jurisdictional study of the implement and evaluation of TAPER among patients with CKD in Canada.

We are conducting a pre-post, controlled study that will leverage data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) linked to provincial administrative databases in Alberta, Manitoba, and Ontario. Adults with CKD and polypharmacy are being recruited from primary care practices across the three provinces. The intervention involves integrating TAPER into providers' clinical workflows, enabling automated medication screening, pharmacist recommendations, and structured follow-up. Our primary outcomes are change in the average number of total medications and inappropriately prescribed medications at 6- and 12-months post-implementation. Secondary outcomes include rates of CKD-appropriate medications, emergency department visits, hospitalizations for adverse drug reactions, CKD-related morbidity and patient and provider satisfaction. Linked administrative data will capture resource utilization and clinical outcomes. Analysis will employ multivariable regression models accounting for patient-level factors and provider clustering.

Patient recruitment is underway. We are actively enrolling providers and their eligible CKD patients through participating CPCSSN sentinel practices. Based on preliminary feasibility data and practice panel sizes, we estimate enrolling approximately 1400 patients over an initial 12-month recruitment period. Data linkage protocols have been established with provincial administrative databases to enable comprehensive outcome assessment.

This work addresses a critical gap in managing the growing epidemic of polypharmacy in patients with CKD and multimorbidity. By implementing and evaluating an evidence-based deprescribing intervention integrated  into primary care workflows, we will provide essential insights into scalable approaches for reducing inappropriate polypharmacy and medication-related harm. The TAPER platform represents a novel EMR-based tool that supports clinical decision-making and integrates patient preferences.