Deprescribing: routine pharmacy practice or an exciting research opportunity?

Wright, David; Scott, Sion; Bhattacharya, Debi

doi:10.1111/ijpp.12513

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…consulta-tions with pharmacists are a perfect opportunity for deprescribing because, like the family doctor, they can avoid sector view and are capable of taking a holistic approach, including into the process all medication coming from all sources, including possibly from prescriptions from multiple specialist doctors and the patient's own over-the-counter drugs and dietary supplements [78]. As the therapeutic schemes of individual patients often differ from each other and are often complex and thus time consuming to review, consultations may be considered a demanding but professionally fulfilling task by some pharmacists while others may prefer to avoid them [79]. in general, however, pharmacists should be available to assess the appropriateness of medications and to optimize the expected health outcomes of pharmacotherapy in elderly patients [80].…”

Section: Resultsmentioning

confidence: 99%

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

Susło,

Horoch-Łyszczarek,

Pochybełko

et al. 2023

fmpcr

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The ongoing increase in the proportion of elderly people in society, sometimes referred to as the aging societies phenomenon, has numerous effects. Multimorbidity affects about every third person in the general population and, on average, the likelihood of chronic illness increases with age, so multimorbidity is more common in older age groups. This increases the demand for medication, leading to concurrent use of many drugs, which is referred to as polypharmacy. we carried out a literature review to identify the problems associated with the use of medications in people sixty years and older. Aging societies contain an increasing number of elderly people struggling with the burden of multimorbidity and the resulting polypharmacy. They require a systemic approach to prescription problems, which include potentially inappropriate medication (PiM) and overprescription, as well as potential prescribing omission (PPo), taking into account issues like lack of patient compliance and self-medication. Any attempt to solve these problems requires tools to objectively evaluate prescription practice, using the existing and emerging capabilities of electronic health records (EHr), actively encouraging all medical personnel who prescribe medications or evaluate their use (including physicians, nurses and pharmacists) to join rational deprescribing attempts, and convincing patients that more drugs are not always better.

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Section: Resultsmentioning

confidence: 99%

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

Susło,

Horoch-Łyszczarek,

Pochybełko

et al. 2023

fmpcr

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“…Thus, deprescribing should also be considered in patients without current health or medication problems. While reactive deprescribing is a routine activity, proactive deprescribing is a new concept for many pharmacists, 34 and it may require more training and support than was offered in our study.…”

Section: Discussionmentioning

confidence: 99%

Process evaluation of a pharmacist‐led intervention aimed at deprescribing and appropriate use of cardiometabolic medication among adult people with type 2 diabetes

Baas

Crutzen

Smits

et al. 2023

Basic Clin Pharma Tox

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BackgroundA quasi‐experimental study investigated a pharmacist‐led intervention aimed at deprescribing and medication management among adult patients with type 2 diabetes at risk of hypoglycaemia.ObjectiveTo evaluate the process of implementing the intervention consisting of a tailored clinical medication review (CMR) supported by a training and a toolbox.MethodsMixed‐methods study based on the Grant‐framework, including the domains ‘recruitment’, ‘delivery of intervention’, and ‘response’ of pharmacists and patients. Data collected were: administrative logs, semi‐structured observations of patient consultations (n=8), interviews with pharmacists (n=16), and patient‐reported experience measure (PREM) questionnaires (n=66).ResultsTailored CMRs were conducted largely as intended for 90 patients from 14 pharmacies. Although patient selection based on a medication‐derived hypoglycaemia risk score was considered useful, pharmacists experienced barriers to proposing deprescribing in patients with recent medication changes, without current hypoglycaemic events, or treated by medical specialists. The training and toolbox were evaluated positively by the pharmacists. Overall, patients were satisfied with the CMR.ConclusionPharmacists and patients valued the CMR focusing on deprescribing and medication management. To optimise implementation and effectiveness of the intervention, improvements can be made to the patient selection, pharmacist training and the collaboration between healthcare professionals.

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“…The decision to deprescribe a medication is a continuous process requiring time, resources, rapport and communication between prescriber, pharmacist and patient. 20,21 Given that hospital admissions are frequently for acute issues, deprescribing often becomes less of a priority. 22,23 An alternative possibility of concern was whether the initial uptake in PPI deprescribing led to more inpatients requiring PPI therapy.…”

Section: Discussionmentioning

confidence: 99%

The impact of deprescribing interventions on oral proton pump inhibitor utilisation in a Singapore tertiary hospital: A quality improvement initiative

Tan

Lee

2022

Ann Acad Med Singap

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Introduction: Proton pump inhibitors (PPIs) are effective treatments for upper gastrointestinal pathologies and short-term courses are well-tolerated. However, indiscriminate use of PPIs is undesirable due to its potential harms. We implemented a series of deprescribing interventions between 2016 and 2017 to curb PPI overutilisation in our institution. The aim of this study was to evaluate the effectiveness and safety of these interventions. Methods: An institutional PPI deprescribing guide was disseminated by email and educational roadshows were conducted to prescribers. Interrupted time series analysis was used to evaluate the effectiveness of the deprescribing interventions over a 7-year period from 2013 to 2019. To ascertain the safety of PPI deprescribing, we analysed the peptic ulcer disease incidence from 2015 to 2018 and conducted a retrospective chart review of 262 inpatients who were deprescribed PPIs. Results: Following the first intervention, there was a significant decrease in mean oral PPI utilisation by 2,324.46 defined daily doses (DDD) per 1,000 prescriptions (95% confidence interval [CI] -3,542.66, -1,106.26) per month, followed by a month-to-month decrease of 302.61 DDD per 1,000 prescriptions per month thereafter (95% CI -473.95, -131.27). A second targeted educational intervention was only effective in sustaining the decline in the outpatient, but not in the inpatient setting. There were no significant changes in incidence of peptic ulcer disease. In the retrospective chart review, a majority (62.6%) of patients remained deprescribed at 6 months. Conclusion: We observed a sustained decrease in PPI utilisation in our institution for more than 12 months following our educational interventions. Cautious deprescribing of PPIs in eligible candidates was found to be safe with low recurrence rates of upper gastrointestinal events. Keywords: Deprescribing, drug utilisation study, interrupted time series analysis, proton pump inhibitor, quality improvement initiative

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Deprescribing: routine pharmacy practice or an exciting research opportunity?

Cited by 7 publications

References 9 publications

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

Process evaluation of a pharmacist‐led intervention aimed at deprescribing and appropriate use of cardiometabolic medication among adult people with type 2 diabetes

The impact of deprescribing interventions on oral proton pump inhibitor utilisation in a Singapore tertiary hospital: A quality improvement initiative

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