Deprescribing Leads to Reduction in Polypharmacy, Inappropriate Medication Use
Researchers aim to understand how deprescribing interventions impacted changes in inappropriate medication use or total prescription drugs among older, community-dwelling adults.
Deprescribing interventions resulted in a reduction of polypharmacy and potentially inappropriate medication (PIM) use among older, community-dwelling adults, according to a study published in JAMA Network Open.1 With the opportunity to decrease patient costs and improve their outcomes, pharmacists may consider adding deprescribing services to boost pharmacy revenue and reach more patients.
“Polypharmacy (commonly defined as using ≥5 chronic medications) and potentially inappropriate medications are associated with adverse drug events, increased health care utilization (eg, emergency department visits, acute care hospitalizations), and greater health care costs,” wrote authors of the study. “These risks are especially relevant for adults aged 65 years and older, given estimates that 45% of older adults are exposed to polypharmacy and 58% to PIMs.”
To combat potential issues spurred by PIMs and polypharmacy, many health care destinations introduced deprescribing services. According to the authors, deprescribing is the “systematic process of identifying and discontinuing drugs…[where] existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals.”1
Researchers determined how various deprescribing interventions could change overall numbers of PIMs and polypharmacy. | image credit: DW labs Incorporated / stock.adobe.com
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In line with the authors’ definition, deprescribing was originally developed to benefit older adults. When the term was first coined in 2003, deprescribing was developed to help the older adult population achieve better health outcomes through the reduction of medications.2 And years later, when clinical settings were allowed to begin billing for deprescribing services, patient outcomes immediately began to improve.
One example of this was in the Veterans Affairs Butler Healthcare System, where deprescribing services were introduced in 2022. Throughout the study, pharmacist-led deprescribing services resulted in both a reduction in polypharmacy and an expansion in pharmacy services.3
“Deprescribing spans health care settings, including outpatient clinics, acute care hospitalizations, long-term care, and community pharmacies,” they wrote.1 “Adults living in the community typically have more independence managing medications, perhaps receiving assistance but not the direct administration of medications that happens in hospital or long-term care settings. As such, deprescribing interventions in this setting may function differently than in other settings.”
In their systematic review and meta-analysis, researchers wanted to better understand the impact of deprescribing services on a larger scale and in a population that may benefit the most from these services. Their objective was to determine how various deprescribing interventions could change overall numbers of PIMs and polypharmacy.
“Deprescribing interventions take many forms, including clinical pharmacist medication reviews, identifying candidate medications based on established criteria, point-of-prescribing clinical decision support, and direct-to-patient educational materials,” continued the authors.1
The researchers started their review by exploring PubMed and Cochrane Library studies that focused solely or primarily on deprescribing. Furthermore, studies were included if they focused on community-dwelling adults and were randomized trials. All studies were published between January 2019 and July 26, 2024.
Their primary outcome was the total number of PIMs, or medications in total, while the secondary outcome was the proportion of patients who were prescribed at least 1 PIM.
“In this systematic review and meta-analysis, we found moderate certainty evidence that deprescribing interventions were associated with reductions in the mean number of medications prescribed to community-dwelling older adults with polypharmacy,” said the authors.1 “However, the estimate was small: on average, approximately 7 patients would need to be exposed to the intervention to get a reduction in 1 prescribed medication.”
Indeed, although results were minimal because of inconsistent study results, the researchers still determined deprescribing as providing a positive change in patients’ medication use. In their interpretation of the analysis, researchers said that these benefits would only be realized in populations exceeding several hundred patients.
“Given that the mean number of baseline medications in the included studies was 9.74, the total number of medications prescribed across 7 typical patients would decrease from 68 to 67,” they wrote. “At the individual level, this benefit is very small. Yet, if the usual primary care clinician has a panel of 2000 patients and at least half of those patients meet the definition of polypharmacy, then a deprescribing intervention applied at the practice level would be expected to reduce the number of prescribed drugs by at least 140 medications.”
While the success of deprescribing services would have to rely on a larger patient population, reviews like this can provide further evidence and encourage other health care destinations to introduce these services. As the older adult population grows, along with their need for various medications, providers—namely pharmacists—have the opportunity to both improve patient outcomes and expand their businesses’ bottom line.
“This systematic review and meta-analysis found moderate certainty evidence that deprescribing interventions were associated with reduced polypharmacy and PIM use in community-dwelling older adults,” concluded the authors.1 “While the outcomes at the individual level were very small, on an aggregated population level, these differences may be large, given the high prevalence of polypharmacy and PIM use in community-dwelling older adults.”
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