Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care

Abstract

A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.

Using Deprescribing Practices and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions Criteria to Reduce Harm and Preventable Adverse Drug Events in Older Adults

“…Among the 3 studies focusing on the use of protocols, algorithms, and clinical decision support systems to promote deprescribing, 2 studies found significant decreases in the number of medications prescribed. Petersen et al 19 found that a patient-centered deprescribing protocol called Shed-MEDS, implemented in 4 phases: (1) medication history and list confirmed, (2) evaluate medication for deprescribing, (3) decide with the patient, and (4) synthesize and communicate recommendations among Medicare beneficiaries prescribed 5 or more medications, significantly reduced the mean number of prescribed medications from 11.6 to 9.1 ( P = 0.032) for those with whom the protocol was used. Garfinkel and Mangin 14 worked with elderly patients in Israel to implement the Good Palliative-Geriatric Practice algorithm, an evidence-based flowchart for medication discontinuation, which recommended discontinuing a total of 311 medications for 64 patients.…”

“…More rigorous, long-term studies with larger sample sizes are needed to further understand deprescribing interventions long-term effects in reducing polypharmacy and preventable ADEs. 12 , 17 , 19 Studies would also be improved if they examined clinical outcomes, not just process or intermediate outcomes. Comparative effectiveness study of different deprescribing interventions, whether single or multicomponent would also be beneficial to the field.…”

Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use

“…describe effective hospital inpatient programs focused on deprescribing prior to discharge. 22–24 Similarly Garfinkel showed positive effects of deprescribing that were sustained longitudinally in a community setting. 25 How to maintain this focus in busy services focused on the multiple needs of complex patients is the challenge.…”

Pharmacists and patients sharing decisions about medicines: Development and feasibility of a conversation guide

“…13 When evaluating medications, clinicians and patients face complex trade-offs which can lead to an emphasis on preference-sensitive decisions. 14,15 There is evidence that taking into account patient goals and preferences improves outcomes 16 and this seems particularly important for optimizing medicines for older patients. 14 Even though patients vary in their preference for involvement in health decisions, most older people want their perspectives to be heard, 17 so it is important for health care professionals to support communication and create opportunities for this.…”