Electronic Deprescribing Interventions Help Older Patients in Long-Term Care
Polypharmacy and potentially inappropriate medications are cited as concerns in older adults who require long-term care, especially for those with comorbidities or at multiple institutions.
Electronic interventions can help long-term care augment deprescribing when paired with the usual workflow. Medication reviews should be incorporated into deprescribing as part of the usual care, according to reviews published in JAMA Network Open.1
Polypharmacy and potentially inappropriate medications are cited as concerns in older adults who require long-term care, especially for those with comorbidities or at multiple institutions. | Image Credit: Eric Hood - stock.adobe.com
Polypharmacy and potentially inappropriate medications (PIMs) are cited as concerns in older adults who require long-term care, especially for individuals with comorbidities and at multiple institutions. In a study published in BMC Geriatrics, the median number of total prescribed medications and PIMs for 67,531 older adults receiving long-term care was 7 and 1, respectively. The main PIMs were loop diuretics/aldosterone agonists, long-term use of proton pump inhibitors, benzodiazepines, and nonsteroidal anti-inflammatory drugs, according to the study authors. They also found that the presence of PIMs was higher for patients with multiple morbidities.2
Investigators of the current study (NCT04762303) aimed to integrate evidence-based electronic deprescribing tools in long-term care in Canada. They implemented MedReviewRx, which is an application allowing MedSafer to analyze a person’s medications and medical conditions and produce a report to simplify the regimen and enhance safety. The reports will help pharmacists and physicians identify PIMs and conduct medication reviews, according to the clinical trial information.1,3
The study implemented MedReviewRx, and an effectiveness analysis was completed. The study lasted approximately 18 months and included 3 clusters with a combined total of approximately 750 nursing home beds. Cluster 1 included 3 months of control and 9 months of intervention; cluster 2 included 6 months of control and 6 months of intervention; and cluster 3 included 9 months of control and 3 months of intervention. In the intervention phase, MedReviewRx was made available for use.3
The primary outcome included the impact of MedReviewRx on the prevalence of PIMs at 3 months. The secondary outcomes included the proportion of patients with 1 or more PIM reductions or stops after each cycle, number of deaths, number of fractures, number of falls, number of restraints, number of transfers to the hospital, and change in function status, among others. Other outcomes included cost savings and patient and family attitudes about deprescribing.3
There were a total of 1228 individuals admitted to 1 of 5 nursing homes at the start of the study, and 725 had 1 or more PIMs prescribed during the study. There were 725 in the control phase, and 621 continued in the intervention phase. In the study, the median number of medications was 10 and the median PIM was 3. The most commonly prescribed PIMs were proton pump inhibitors, anticoagulants, and benzodiazepines or sedative hypnotics.1
In the control phase, investigators found that 12.7% of patients had 1 or more PIMs deprescribed compared with 36.4% in the intervention phase. The most common medications deprescribed were opioids, antipsychotics, docusate, and benzodiazepines or sedative hypnotics, according to the study authors. Although the study was not optimized for individual medication classes, the least likely affected medications were nonsteroidal anti-inflammatories and gabapentinoids. Falls were statistically higher in the intervention group, and the prevalence of delirium was overall low.1
READ MORE: Technology and Data Resource Center
Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our free Drug Topics newsletter.
