Pharmacist‐led medication review in a residential in‐reach service leads to deprescribing

Abstract

AbstractObjectiveTo examine the effect of a pharmacist‐led medication review on deprescribing medications in a Residential In‐Reach (RIR) service which provides acute care substitution to residential aged care residents.MethodsA pre‐post observational study was conducted. Patient characteristics and admission and discharge medications were collected over two 3‐month phases before (prephase) and after (postphase) the introduction of a pharmacist who performed a comprehensive medication review and provided deprescribing recommendations. The Screening Tool of Older Persons' Prescriptions (STOPP) version 2 was used to identify potentially inappropriate medications (PIMs). The Drug Burden Index (DBI) was used to measure cumulative anticholinergic and sedative medication burden. Outcome of deprescribing was measured by the reduction in the number of PIMs, DBI scores and proportion of polypharmacy from admission to discharge.ResultsThe prephase included 59 patients (mean age 87.3 years, 63% female), and the postphase included 88 patients (mean age 87.3 years, 63% female). There was a significant reduction in the mean number of PIMs (pre +0.05 ± 2.59 vs. post −0.78 ± 2.32, p = 0.04) and median DBI (pre −0.004 ± 0.17 vs. post −0.07 ± 0.2, p = 0.03) in postphase compared to prephase. The proportion of polypharmacy at discharge was reduced in the postphase (pre‐100% vs. post‐90%, p = 0.01). The most deprescribed PIMs as measured by STOPP in postphase were drugs without indication, cardiovascular system drugs and gastrointestinal system drugs.ConclusionsThe introduction of a pharmacist‐led medication review in RIR service was associated with a significant reduction in the mean number of PIMs, median DBI and polypharmacy. Future studies are needed to determine whether deprescription is sustained to examine correlations to long‐term patient outcomes.