Pharmacists effective in facilitating deprescribing

In 2015 the American Geriatrics Society promulgated an updated version of the “Beers Criteria” list of drugs to avoid in older adults, drugs that are unsuited for use in the older person because of the risk of harm and availability of safer treatments. Despite this, many prescriptions for these medications are written for older people every day. Canadian researcher have recently published the results of research that involved pharmacists in the intervention group who were encouraged to send patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion to recommend deprescribing (248 patients). This was compared to a group where control pharmacists provided usual care (241 patients). Patients, physicians, pharmacists, and evaluators were blinded to outcome assessment. The main outcome evaluated was discontinuation of prescriptions for inappropriate medication at six months, ascertained by pharmacy medication renewal profiles. At the endpoint, 106 of 248 patients (43%) in the intervention group no longer filled prescriptions for inappropriate medication compared with 29 of 241 (12%) in the control group (risk difference, 31% [95% CI, 23% to 38%]). Subgroup analysis revealed substantial discontinuation of inappropriate sedative-hypnotic drug use in the intervention group (43.2%) vs (9.0%), for controls (risk difference, 34% [95% CI, 25% to 43%]). Similar substantial reductions were observed with glyburide (glibenclamide) and NSAIDs. Of some concern, 29 of 77 patients (38%) who attempted to taper sedative-hypnotics reported withdrawal symptoms. A useful demonstration of the power of prescriber feedback delivered through interdisciplinary intervention. Read the full paper here.