Implementation of a compulsory clinical pharmacist‐led medication deprescribing intervention in high‐risk seniors in the emergency department

Abstract

Objectives The objective of this study was to assess the impact of an emergency department (ED) deprescribing intervention for geriatric adults. We hypothesized that pharmacist‐led medication reconciliation for at‐risk aging patients would increase the 60‐day case rate of primary care provider (PCP) deprescribing of potentially inappropriate medications (PIMs). Methods This was a retrospective, before‐and‐after intervention pilot study conducted at an urban Veterans Affairs ED. In November 2020, a protocol utilizing pharmacists to perform medication reconciliations for patients 75 years or older who screened positive using an Identification of Seniors at Risk tool at triage was implemented. Reconciliations focused on identifying PIMs and providing deprescribing recommendations to patients' PCPs. A preintervention group was collected between October 2019 and October 2020, and a postintervention group was collected between February 2021 to February 2022. The primary outcome compared case rates of PIM deprescribing in the preintervention group to the postintervention group. Secondary outcomes include per‐medication PIM deprescribing rate, 30‐day PCP follow‐up visits, 7‐ and 30‐day ED visits, 7‐ and 30‐day hospitalizations, and 60‐day mortality. Results A total of 149 patients were analyzed in each group. Both groups were similar in age and sex, with an average age of 82 years and 98% male. The case rate of PIM deprescribing at 60 days was 11.1% preintervention compared to 57.1% postintervention (p < 0.001). Preintervention, 91% of PIMs remained unchanged at 60 days compared to 49% (p < 0.05) postintervention. Regardless of PIM identification, the 30‐day primary care follow‐up rate increased postintervention: 31.5% and 55.7% (p < 0.0001), respectively. There was no improvement in 7‐ or 30‐day subsequent ED visits, hospitalization, or mortality. Conclusions Pharmacist‐led medication reconciliation in high‐risk geriatric patients was associated with an increase both in the rate of PIM deprescribing and in post‐ED primary care engagement.

Influence of Potentially Inappropriate Medication Use on Older Australians’ Admission to Emergency Department Short Stay

“…To address these challenges and enhance patient care, various strategies can be employed, including those aimed at preventing admission and addressing needs during the admission process: Comprehensive medication reviews by EM pharmacists: EM pharmacists can play a pivotal role in conducting thorough medication reviews, identifying PIMs, and initiating deprescribing interventions [ 45 , 46 ]. Interventions made by EM pharmacists such as medication reconciliation and providing deprescribing suggestions to at-risk patients have led to a ten-fold increase in deprescribing of PIMs by primary care physicians [ 47 ]. Education on deprescribing: Providing education to healthcare professionals, including pharmacists and doctors, is essential to empower them with the knowledge and skills needed for effective deprescribing [ 43 , 44 ].…”

“…Comprehensive medication reviews by EM pharmacists: EM pharmacists can play a pivotal role in conducting thorough medication reviews, identifying PIMs, and initiating deprescribing interventions [ 45 , 46 ]. Interventions made by EM pharmacists such as medication reconciliation and providing deprescribing suggestions to at-risk patients have led to a ten-fold increase in deprescribing of PIMs by primary care physicians [ 47 ].…”

Revisão da farmacoterapia intra-hospitalar: análise de risco e de rede

“…It is also worth highlighting the DRPs involving benzodiazepines, as they were absent from the pharmacists' list and present in the physicians' assessment. According to studies by Fick and Jovevski, which deal with the inappropriate medication use in older adults, the decision on the benzodiazepine dose to be used was considered a determining factor for future complications31,32 . In the same research studies, other drugs considered inappropriate for older adults were discontinued or had their doses reduced after PhIs performed in emergency care.…”

“…In the same research studies, other drugs considered inappropriate for older adults were discontinued or had their doses reduced after PhIs performed in emergency care. Muscle relaxants, hypnotics, benzodiazepines and alpha-adrenergic receptor blockers stood out among the agents involved in the PhIs31,32 . The current study suggested the prescribers' concern about the safety and risk of bleeding and excessive sedation inherent to these medications, which would be life-threatening conditions.…”