Reducing inappropriate polypharmacy: the process of deprescribing

Scott, Ian A., Hilmer, Sarah N., Reeve, Emily, Potter, Kathleen, Couteur, David Le, Rigby, Deborah, Gnjidic, Danijela, Del Mar, Christopher B., Roughead, Elizabeth E., Page, Amy, Jansen, Jesse and Martin, Jennifer H. (2015) Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Internal Medicine, 175 5: 827-834. doi:10.1001/jamainternmed.2015.0324

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Author Scott, Ian A.
Hilmer, Sarah N.
Reeve, Emily
Potter, Kathleen
Couteur, David Le
Rigby, Deborah
Gnjidic, Danijela
Del Mar, Christopher B.
Roughead, Elizabeth E.
Page, Amy
Jansen, Jesse
Martin, Jennifer H.
Title Reducing inappropriate polypharmacy: the process of deprescribing
Journal name JAMA Internal Medicine   Check publisher's open access policy
ISSN 2168-6106
2168-6114
Publication date 2015-05-01
Year available 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1001/jamainternmed.2015.0324
Open Access Status File (Publisher version)
Volume 175
Issue 5
Start page 827
End page 834
Total pages 8
Place of publication Chicago, IL United States
Publisher American Medical Association
Collection year 2016
Language eng
Abstract Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed drugs. Deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies. A deprescribing protocol is proposed comprising 5 steps: (1) ascertain all drugs the patient is currently taking and the reasons for each one; (2) consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention; (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential; (4) prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes; and (5) implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Whereas patient and prescriber barriers to deprescribing exist, resources and strategies are available that facilitate deliberate yet judicious deprescribing and deserve wider application.
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Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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