Deprescribing Interventions Could Safely Reduce Number of Potentially Inappropriate Prescriptions
Pharmacist-led deprescribing can help reduce the number of medications a patient is taking in an effective way.
Interventions targeted at inappropriate prescribing can be implemented to safely reduce the number of medications that are prescribed to older adults in primary care settings, according to results of a review in JAMA Network Open. Investigators said future studies should evaluate interventions using standardized criteria and reports on potential harm.1
Pharmacist-led deprescribing can help to reduce the number of medications in an effective way, as pharmacists are the medication experts. | Image Credit: Eric Hood - stock.adobe.com
“Meta-analysis showed that PIP interventions were associated with a reduction in the number of medications prescribed, without statistically significant differences in other outcomes such as hospitalizations and all-cause mortality,” the study authors said.1
One intervention could include medication reviews, which can be incorporated as usual care. In one study, investigators implemented MedReviewRx, an application that analyzes a person’s medications and medical conditions to produce a report that simplifies the regimen and enhances safety. Deprescribing interventions, which consists of identifying and discontinuing drugs when the harms outweigh the benefits, is another method that can be effective.2,3
Community pharmacists are aptly positioned to lead deprescribing efforts. Deprescribing is reliant on individual patients, so pharmacist-led deprescribing can help to reduce the number of medications in an effective way, as pharmacists are the medication experts. Future research should utilize pharmacists’ knowledge to improve health outcomes, especially for older patients and deprescribing efforts.4
In the current review, investigators aimed to determine the association between interventions to address potentially inappropriate prescribing (PIP) in older outpatients as well as with changes in outcomes. They included randomized controlled trials that focused on interventions to address PIPs in adults 65 years and older who were in community or long-term care facilities, such as nursing homes or assisted-living facilities. The primary outcomes included all-cause mortality, hospitalizations, and nonserious adverse drug events, and secondary outcomes included quality of life, emergency department visits, medical visits, injurious falls, and number of medications.1
A total of 118 trials were included, with a total of 417,412 patients (212,090 receiving an intervention and 205,322 as controls). Approximately 79% included patients in ambulatory care settings and 21% included long-term care facilities. Further, just over half (51%) involved a pharmacist and 27% included software reviews of medications. The most commonly reported outcomes included medications prescribed (40%), hospitalizations (26%), and all-cause mortality (45%). Approximately 64% of studies had a low risk of bias, 34% had some risk of bias, and 2% had a high risk of bias.1
Of 43 trials with data that could be pooled, PIP interventions were associated with a reduction in the number of prescribed medications corresponding to approximately 0.5 medications per patient. Nonserious adverse events were only reported in 3 trials, and there was no clear association between PIP interventions and nonserious adverse events. Further, for injurious falls, there was no association between PIP interventions and number of falls in 21 trials. As for quality of life and medical outpatient visits, investigators did not find associations between improvements in either and PIP interventions. The same was true for emergency department visits. There were small reductions in hospitalizations and all-cause mortality, but neither was statistically significant.1
“Our findings complement and expand on those of previous systematic reviews. However, our review included a wider range of interventions, including a variety of PIP interventions beyond deprescribing of specific drug classes, which likely contributed to the larger number of included studies,” the study authors concluded.1
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