Clinical question: Can inpatient deprescribing interventions upon post-acute care facility discharge reduce the total medication burden?
Dr. Kaur
Background: Polypharmacy remains a common concern in elderly patients due to associated adverse health outcomes. While deprescribing can be an important therapeutic intervention, it is usually practiced in primary care settings. There is underutilization of deprescribing in inpatient settings due to limited data and unclear information on the safety and effectiveness of deprescribing.
Study design: Randomized controlled trial, May 2016 to October 2020
Setting: Vanderbilt University Medical Center, Nashville, Tenn.
Synopsis: 284 patients (mean age 76.2 years; 83% white, 62% females) admitted to the hospital and later discharged to a post-acute care facility (PAC) were randomized 1:1 to the deprescribing or control group. Interventions, led by pharmacists or clinicians, were initiated in the hospital and continued throughout the PAC with a 90-day follow-up. The deprescribing group took a mean of 14% fewer medications at discharge to PAC and 15% fewer medications at the 90-day follow-up (mean ratio, 0.85; 95% CI, 0.78-0.92; P <.001). There was a statistically significant reduction in exposure to inappropriate medications and combined anticholinergic and sedative burden. No increase in adverse drug events nor adverse drug withdrawal events in the deprescribing group was noticed.
Limitations include non-blinded study design, potential enrollment bias, limited generalizability due to a single center, and predominantly white, English-speaking participants.
Bottom line: Inpatient patient-centered deprescribing can safely reduce drug burden without increasing adverse effects, emphasizing its importance at discharge.
Citation: Vasilevskis EE, et al. Deprescribing medications among older adults from end of hospitalization through postacute care: A shed-MEDS randomized clinical trial. JAMA Intern Med. 2023;183(3):223-31.
Dr. Kaur is a hospitalist and assistant professor of medicine at the University of New Mexico Hospital, Albuquerque, N.M.