A Collaborative Medication Review Including Deprescribing for Older Patients in an Emergency Department: A Longitudinal Feasibility Study

Abstract

Medication review for older patients with polypharmacy in the emergency department (ED) is crucial to prevent inappropriate prescribing. Our objective was to assess the feasibility of a collaborative medication review in older medical patients (≥65 years) using polypharmacy (≥5 long-term medications). A pharmacist performed the medication review using the tools: Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, a drug–drug interaction database (SFINX), and Renbase® (renal dosing database). A geriatrician received the medication review and decided which recommendations should be implemented. The outcomes were: differences in Medication Appropriateness Index (MAI) and Assessment of Underutilization Index (AOU) scores between admission and 30 days after discharge and the percentage of patients for which the intervention was completed before discharge. Sixty patients were included from the ED, the intervention was completed before discharge for 50 patients (83%), and 39 (61.5% male; median age 80 years) completed the follow-up 30 days after discharge. The median MAI score decreased from 14 (IQR 8-20) at admission to 8 (IQR 2-13) 30 days after discharge (p < 0.001). The number of patients with an AOU score ≥1 was reduced from 36% to 10% (p < 0.001). Thirty days after discharge, 83% of the changes were sustained and for 28 patients (72%), 1≥ medication had been deprescribed. In conclusion, a collaborative medication review and deprescribing intervention is feasible to perform in the ED.

A Collaborative Deprescribing Intervention in a Subacute Medical Outpatient Clinic: A Pilot Randomized Controlled Trial

“…The physician implemented 69% of the recommended deprescribed medications by the clinical pharmacist. This is within the implementation range of 61–90% reported by other studies with collaboration between pharmacists and physicians [ 16 , 24 , 25 ]. Considering the subacute setup for patients with symptoms requiring treatment, our reported implementation rate of 69% indicates that collaboration between pharmacists and physicians is feasible.…”

“…Moreover, in a Danish longitudinal feasibility study by Houlind et al, 1.6 medications were on average deprescribed based on a pharmacist–geriatric medication review intervention in the emergency department. The most frequently deprescribed medications observed by Houlind et al were proton pump inhibitors, analgesics, antihypertensives, and statins [ 16 ]. In contrast to our study, Marvin et al and Houlind et al found no difference in the total number of medications prior to intervention and during follow-up.…”

“…However, most published randomized controlled trials (RCT) on medication reviews as a single intervention (without a follow-up) have found little effect on hospital admission, readmission, and mortality [ 13 , 14 , 15 ]. One reason could be that completing medication reconciliation at sector crossings is complex, and medication changes are often incompletely transferred to the medication list on discharge [ 16 , 17 ]. This could be due to a lack of collaboration between pharmacists and physicians, resulting in insufficient implementation of suggested medication changes.…”

Risk of Hospital Readmission among Older Patients Discharged from the Rehabilitation Unit in a Rural Community Hospital: A Retrospective Cohort Study

“…A previous study showed that discontinuing sleep and depressive drugs can improve cognitive function in this population [ 53 ]. As polypharmacy can be easily missed during acute treatment, healthcare professionals should carefully assess the number of medications taken by the patient and implement active measures to lower polypharmacy after shared decision-making with the patients and their families [ 54 , 55 , 56 ].…”

Alterations of monocyte NF-κB p65/RelA signaling in a cohort of older medical patients, age-matched controls, and healthy young adults

“…This study uses data collected as part of FAM-CPH , an observational cohort study aiming to investigate mechanisms of biological aging and chronic inflammation, as well as malnutrition, and medication in acutely ill and healthy older adults as well as healthy young adults. Previous results from FAM-CPH regarding drug prescription have been published elsewhere [ 27 ]. FAM-CPH was approved by the Health Research Ethics Committee for the Capital Region of Denmark (H-16038786), the Danish Data Protection Agency (AHH-2016-067) and was registered at Clinicaltrials.gov (NCT03052192).…”