A medication review and deprescribing method for hospitalised older patients receiving multiple medications

McKean, M., Pillans, P. and Scott, I. A. (2016) A medication review and deprescribing method for hospitalised older patients receiving multiple medications. Internal Medicine Journal, 46 1: 35-42. doi:10.1111/imj.12906


Author McKean, M.
Pillans, P.
Scott, I. A.
Title A medication review and deprescribing method for hospitalised older patients receiving multiple medications
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
1445-5994
Publication date 2016-01
Sub-type Article (original research)
DOI 10.1111/imj.12906
Volume 46
Issue 1
Start page 35
End page 42
Total pages 8
Place of publication Richmond, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2017
Language eng
Formatted abstract
Background
Prescribing of multiple medications in older patients poses risk of adverse drug events.

Aim
To determine whether a structured approach to deprescribing – identifying and discontinuing unnecessary medications – in the inpatient setting is feasible and reduces medication burden.

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 eight or more regular medications on presentation. The intervention comprised an education programme and a paper-based or computerised proforma listing clinical and medication data linked with a five-step decision support tool for selecting drugs eligible for discontinuation, which were then ceased or were being weaned by the time of discharge.

Results
Among 50 patients of median age 82.5 years and six co-morbidities, 186 of 542 (34.3%) regular medications were discontinued, representing a significant decrease in the median (interquartile range) number of medications per patient at discharge compared with presentation (7 (5–9) vs 10 (9–12), P < 0.001). Medication lists were reduced by at least two medications in 84% of patients, and by four or more in 50%. Statins, gastric acid suppressive agents, angiotensin-converting enzyme 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 because of symptom relapse.

Conclusion
A standardised method of medication review and deprescribing may significantly reduce medication burden in a cohort of older hospitalised patients.
Keyword Medication
Review
Older patient
Deprescribing
Elderly
Polypharmacy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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