A medication review and deprescribing method for hospitalised older patients receiving multiple medications.
Intern Med J. 2015 Sep 20;
Authors: McKean M, Pillans PI, Scott IA
Abstract
BACKGROUND: Prescribing of multiple medications in older patients poses risk of adverse drug events. Whether a structured approach to deprescribing - identifying and discontinuing unnecessary medications - in the inpatient setting is feasible and reduces medication burden is unclear.
METHODS: Prospective pilot study of a convenience sample of patients aged ≥65 years admitted acutely to general medicine units in a tertiary hospital and receiving 8 or more regular medications on presentation. The intervention comprised an education program and a paper-based or computerised proforma listing clinical and medication data linked with a 5-step decision support tool for selecting drugs eligible for discontinuation which were then ceased or weaned by the time of discharge.
RESULTS: Among 50 patients of median age 82.5 years and 6 co-morbidities, 186 of 542 (34.3%) regular medications were discontinued, representing a significant decrease in the median (interquartile range [IQR]) number of medications per patient at discharge compared to presentation (7 [5-9]) versus 10 [9-12], p < 0.001). Medication lists were reduced by at least two medications in 84%, and by four or more in 50%. Statins, gastric acid suppressive agents, ACE inhibitors/angiotensin receptor antagonists and inhaled bronchodilators were the most frequently ceased medications. Of 39 patients in whom follow-up status at a median of 78 days was ascertained, only 5 of 413 (1.2%) ceased medications were recommenced among three patients due to symptom relapse.
CONCLUSION: A standardised method of medication review and deprescribing may significantly reduce medication burden in a cohort of older hospitalised patients. This article is protected by copyright. All rights reserved.
PMID: 26387783 [PubMed - as supplied by publisher]