In-hospital deprescribing in the real world – a clinician-led approach to hyperpolypharmacy

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2023-01-17 DOI:10.1002/jppr.1844

Jaidyn Muhandiramge MD, BMedSc(Hons), Tara Dev MD, BMedSc(Hons), Jason Kong MBBS(Hons), BMedSc(Hons), Kylie Hall BN, Vikas Wadhwa MBBS, MBA, MPH

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引用次数: 1

Abstract

Background

A lack of clear guidelines for medication cessation has contributed to the proliferation of polypharmacy. Hospitalisation provides a unique opportunity for initiating deprescribing. Deprescribing interventions are usually pharmacist- or multidisciplinary team-led and are typically safe and beneficial for patients. However, few studies have explored interventions that are implementable by clinicians at the bedside.

Aim

To explore the efficacy and feasibility of a clinician-led deprescribing intervention on an acute general medicine ward.

Method

A multifaceted intervention was implemented comprising (a) education sessions on deprescribing and (b) a deprescribing alert in the bedside folders of patients with hyperpolypharmacy (>10 medications). Using a historical cohort study design, data from the intervention cohort were compared to a historical control group. A subset of the intervention cohort was surveyed after discharge regarding attitudes toward deprescribing.

Results

We recruited 1333 patients and had complete data for 1169 (n_intervention = 888, n_control = 281). The prevalence of hyperpolypharmacy decreased from 28% to 26% in the intervention cohort, but this reduction was not statistically significant (net change = −1, interquartile range [IQR] = −2–0; p = 0.26). There was similarly no statistically significant change in medication numbers due to the intervention across other subgroups. Most patients agreed they were taking too many medications and supported deprescribing.

Conclusions

Despite observing no statistically significant effect of the intervention, we demonstrated the feasibility of introducing clinician-led deprescribing interventions in resource-poor, busy inpatient units. Simple, innovative deprescribing interventions in hospital settings, along with the measurement of long-term patient outcomes and medication adverse effects, should be investigated further in large inpatient cohorts.

Abstract Image

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现实世界中的医院处方——临床医生主导的多药治疗方法

缺乏明确的停药指南导致了多药治疗的激增。住院治疗提供了一个独特的机会来启动取消描述。描述性干预通常由药剂师或多学科团队领导，通常对患者安全有益。然而，很少有研究探讨临床医生可以在床边实施的干预措施。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.