Effectiveness of pharmacist intervention for deprescribing potentially inappropriate medications: a prospective observational study

Abstract

Background Potentially inappropriate medications (PIMs) and polypharmacy in older adults lead to increase the risk of adverse drug events. This study aimed to evaluate the effectiveness of pharmacist intervention combining the criteria for detecting PIMs with the deprescribing algorithm on correcting PIMs, reducing the number of medications, and readmissions. Methods A prospective observational study was conducted at a Japanese University Hospital enrolling new inpatients aged ≥65 years prescribed ≥1 daily medication. Pharmacists detected PIMs based on the criteria combined the screening tool of older persons’ potentially inappropriate prescriptions criteria version 2 with the screening tool for older persons’ appropriate prescriptions for Japanese, examined changes using the deprescribing algorithm, and suggested changes to the physician. The proportion of patients whose number of medications was reduced at discharge and the rate of readmissions within 30 and 90 days were compared between patients without PIMs (without PIMs group), patients who were not suggested to change PIMs (no suggestions group), and patients who were suggested to change PIMs (suggested group). Results The study enrolled 544 patients (median age 75.0 years, 54.4% males, median number of medications 6.0/patient). The number of patients with PIMs was 240 (44.1%), and 304 patients had no PIMs (without PIMs group). Among the patients with PIMs, 125 (52.1%) patients received pharmacist suggestions to change ≥1 PIMs (suggested group), and 115 patients received no suggestions for change (no suggestions group). The total number of PIMs was 432, of which changes were suggested for 189 (43.8%). Of these 189 cases, 172 (91.0%) were changed. The proportion of patients whose number of medications was reduced was significantly higher in the suggested group than in the without PIMs group and the no suggestions group [56.8% (71/125) vs. 26.6% (81/304) and 19.1% (22/115), respectively; P < 0.001 in both comparisons]. There were no significant differences in the rates of readmissions within 30 and 90 days among the three groups. Conclusions Pharmacist intervention combining the criteria for detecting PIMs with the deprescribing algorithm was effective for correcting PIMs and may be associated with a reduction in the number of medications.

The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia

“…As mentioned earlier, PIMs are associated with different noxious effects. Thus, it is crucial to review older patients’ medications regularly and deprescribe unnecessary and inappropriate medications to reduce polypharmacy and PIMs and their consequences [ 34 ]. However, several barriers to deprescribing were identified in the literature.…”

Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol

“…This trial aims to assess the feasibility, safety, and effectiveness of a locally developed deprescribing intervention utilizing explicit criteria (MALPIP) for older adults during hospital admission and discharge. Previous studies have demonstrated the effectiveness of deprescribing interventions using explicit criteria in reducing potentially inappropriate medications (PIM), chronic medications, adverse drug reactions, and drug interactions [ 14 – 16 ].…”

“…Systematic review of randomized controlled trials demonstrated that deprescribing reduced medication burden and positively impacts health-related quality of life, costs, and hospitalization [ 13 ]. Deprescribing interventions also reduced medication errors and potential drug–drug interactions [ 14 – 16 ]. While studies have demonstrated the effectiveness of explicit PIM criteria in improving older patients’ outcomes, most relied on the Western PIM criteria, such as START-STOPP and Beers criteria [ 17 – 19 ].…”

Hospitalization and emergency department visits associated with potentially inappropriate medication in older adults: self-controlled case series analysis

“…Meanwhile, several randomized clinical trials have demonstrated the efficacy of pharmacist interventions in correcting PIMs ( 49 , 50 ), long-term discontinuation of PIMs ( 51 ), and reduction in the number of medications prescribed ( 52 ). As the prevalence and type of PIMs vary by country and healthcare setting ( 53 ), contextualized measures based on these variations should be developed in each country.…”