Implementation of a Standardized Palliative Care Pharmacist Deprescribing Assessment.

IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Journal of palliative medicine Pub Date : 2025-05-01 Epub Date: 2025-03-20 DOI:10.1089/jpm.2024.0215
Ibtihal I Makki, Heather K Cook, Nicole Bartell, Mary Lynn McPherson, Lauren R Bangerter, Kathryn A Walker
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Abstract

Background: Palliative care (PC) patients are at high risk of polypharmacy, thereby imposing a substantial burden on patients, including increased pill burden, adverse drug events, and falls. PC pharmacists play a critical role in deprescribing and aligning medications with goals of care for this population, but few studies demonstrate deprescribing opportunities. Objectives: The purpose of this study was to (1) summarize deprescribing opportunities among a sample of hospitalized PC patients, (2) identify patient variables associated with deprescribing opportunities, and (3) summarize deprescribing recommendations, implementation, and short-term clinical harm outcomes. Design: We conducted a retrospective review of the electronic health record. Setting/Subjects: All adult patients across six hospitals in Washington, DC, and Maryland referred to inpatient PC consultation service during the study period were included in this study. Results: Among 125 patients referred to the PC service, 84.5% were evaluated by a PC pharmacist for deprescribing opportunities, and 39.2% were appropriate for deprescribing. There was an average of 3.4 deprescribing recommendations made per patient. White patients and patients with higher severity of illness were significantly more likely to be deprescribing appropriately. The most commonly deprescribed medication classes were bowel regimens and electrolyte repletion, vitamins, and fluids. Deprescribing recommendations were widely accepted by inpatient primary care teams and patients and their caregivers. No short-term clinical harm was observed for patients with deprescribing recommendations implemented. Conclusion: Approximately two in five PC patients in this study were appropriate for deprescribing. PC pharmacists are effective at assessing and implementing deprescribing opportunities.

实施标准化姑息治疗药剂师处方评估。
背景:姑息治疗(PC)患者面临多重用药的高风险,从而给患者带来了巨大的负担,包括增加的药丸负担、药物不良事件和跌倒。PC药剂师在为这一人群开处方和调整药物与护理目标方面发挥着关键作用,但很少有研究表明开处方的机会。目的:本研究的目的是(1)总结住院PC患者的开处方机会,(2)确定与开处方机会相关的患者变量,(3)总结开处方建议、实施和短期临床伤害结果。设计:我们对电子健康记录进行了回顾性审查。背景/对象:华盛顿特区和马里兰州六家医院在研究期间转介到住院PC咨询服务的所有成年患者纳入本研究。结果:125例转介到PC服务的患者中,84.5%的患者被PC药师评价为有机会开处方,39.2%的患者适合开处方。平均每位患者有3.4个处方推荐。白人患者和疾病严重程度较高的患者更有可能适当地开处方。最常见的处方药物是肠道疗法、电解质补充、维生素和液体。减少处方的建议被住院初级保健团队和患者及其护理人员广泛接受。没有观察到实施处方推荐的患者的短期临床危害。结论:本研究中约五分之二的PC患者适合开处方。PC药剂师在评估和实施处方减少的机会是有效的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of palliative medicine
Journal of palliative medicine 医学-卫生保健
CiteScore
3.90
自引率
10.70%
发文量
345
审稿时长
2 months
期刊介绍: Journal of Palliative Medicine is the premier peer-reviewed journal covering medical, psychosocial, policy, and legal issues in end-of-life care and relief of suffering for patients with intractable pain. The Journal presents essential information for professionals in hospice/palliative medicine, focusing on improving quality of life for patients and their families, and the latest developments in drug and non-drug treatments. The companion biweekly eNewsletter, Briefings in Palliative Medicine, delivers the latest breaking news and information to keep clinicians and health care providers continuously updated.
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