Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults

Herrinton, Lisa J.; Lo, K.L.; Alavi, Mubarika; Alexeeff, Stacey; Butler, Kathleen; Chang, Chih-Hung; Chang, Christopher; Chu, Vanessa; Krishnaswami, Ashok; Deguzman, Lynn; Prausnitz, Stephanie; Mason, Michael D.; Draves, Maisha

doi:10.1001/jamanetworkopen.2023.22505

Cited by 4 publications

(4 citation statements)

References 45 publications

(158 reference statements)

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“…The Kaplan-Meier survival curve of the primary outcome revealed no trend suggesting a potential difference between groups toward the latter half of the 12-month period. This is in line with previous deprescribing studies with no demonstrable effects on clinical end points . There are several possible explanations why the intervention did not improve the primary end point.…”

Section: Discussionsupporting

confidence: 91%

“…This study demonstrated the safety of deprescribing in hospitalized patients with a high mortality rate in which more than 20% died during the 1-year follow-up. Mortality rates during the study period among previous studies ranged from 2.1% to 11.3% in the primary care setting, and from 5.6% at 90 days to 19.2% at 1 year in the inpatient setting, suggesting that our study population had a higher morbidity and mortality than previously reported studies. Our results corroborate the safety of deprescribing interventions in older inpatients with polypharmacy.…”

Section: Discussionmentioning

confidence: 43%

“…This is in line with previous deprescribing studies with no demonstrable effects on clinical end points. 28 , 33 , 34 , 35 There are several possible explanations why the intervention did not improve the primary end point. The high mortality of the study participants, which is a competing risk for unscheduled hospital visits and rehospitalization, may have led to an underestimation of the effect of the intervention.…”

Section: Discussionmentioning

confidence: 99%

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Medication Optimization Protocol Efficacy for Geriatric Inpatients

Ie,

Hirose,

Sakai

et al. 2024

JAMA Netw Open

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ImportanceThere is currently no consensus on clinically effective interventions for polypharmacy among older inpatients.ObjectiveTo evaluate the effect of multidisciplinary team-based medication optimization on survival, unscheduled hospital visits, and rehospitalization in older inpatients with polypharmacy.Design, Setting, and ParticipantsThis open-label randomized clinical trial was conducted at 8 internal medicine inpatient wards within a community hospital in Japan. Participants included medical inpatients 65 years or older who were receiving 5 or more regular medications. Enrollment took place between May 21, 2019, and March 14, 2022. Statistical analysis was performed from September 2023 to May 2024.InterventionThe participants were randomly assigned to receive either an intervention for medication optimization or usual care including medication reconciliation. The intervention consisted of a medication review using the STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria, followed by a medication optimization proposal for participants and their attending physicians developed by a multidisciplinary team. On discharge, the medication optimization summary was sent to patients’ primary care physicians and community pharmacists.Main Outcomes and MeasuresThe primary outcome was a composite of death, unscheduled hospital visits, and rehospitalization within 12 months. Secondary outcomes included the number of prescribed medications, falls, and adverse events.ResultsBetween May 21, 2019, and March 14, 2022, 442 participants (mean [SD] age, 81.8 [7.1] years; 223 [50.5%] women) were randomly assigned to the intervention (n = 215) and usual care (n = 227). The intervention group had a significantly lower percentage of patients with 1 or more potentially inappropriate medications than the usual care group at discharge (26.2% vs 33.0%; adjusted odds ratio [OR], 0.56 [95% CI, 0.33-0.94]; P = .03), at 6 months (27.7% vs 37.5%; adjusted OR, 0.50 [95% CI, 0.29-0.86]; P = .01), and at 12 months (26.7% vs 37.4%; adjusted OR, 0.45 [95% CI, 0.25-0.80]; P = .007). The primary composite outcome occurred in 106 participants (49.3%) in the intervention group and 117 (51.5%) in the usual care group (stratified hazard ratio, 0.98 [95% CI, 0.75-1.27]). Adverse events were similar between each group (123 [57.2%] in the intervention group and 135 [59.5%] in the usual care group).Conclusions and RelevanceIn this randomized clinical trial of older inpatients with polypharmacy, the multidisciplinary deprescribing intervention did not reduce death, unscheduled hospital visits, or rehospitalization within 12 months. The intervention was effective in reducing the number of medications with no significant adverse effects on clinical outcomes, even among older inpatients with polypharmacy.Trial RegistrationUMIN Clinical Trials Registry: UMIN000035265

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medication Optimization Protocol Efficacy for Geriatric Inpatients

Ie,

Hirose,

Sakai

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

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“…Over the past decade, multiple randomized controlled trials have tested interventions for deprescribing, including physician–pharmacist collaborative drug therapy management, mailing of educational brochure to patients and providers, and training sessions and family conferences for prescribers tailored for deprescribing. 18 , 19 , 20 Although some of these approaches have successfully reduced pill counts, further studies are needed to explore the effectiveness of these interventions in kidney care settings and on long-term outcomes (eg, hospitalizations, withdrawal events after deprescribing, ADE reduction, and patient-reported outcomes). As robust electronic platforms for deprescribing support are further developed, attention should also remain on tools that support effective shared decision making and patient-centered communication.…”

mentioning

confidence: 99%

Deprescribing in Dialysis: Operationalizing “Less is More” Through a Multimodal Deprescribing Intervention

Vijayan,

Mohottige

2024

Kidney Medicine

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The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis

Quek,

Page,

Lee

et al. 2024

Brit J Clinical Pharma

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AimsPrevious systematic reviews suggest that deprescribing may improve survival, particularly in frail older people. Evidence is rapidly accumulating, suggesting a need for an updated review of the literature.MethodsWe updated a 2016 systematic review and meta‐analysis to include studies published from inception to 26 April 2024 from specified databases. Studies in which older people had at least one medication deprescribed were included and grouped by study designs and targeted medications. The risk of bias was assessed using the Cochrane tool and the Newcastle‐Ottawa tool. Odds ratios (OR) or mean differences were calculated as the effect measures using either the Mantel–Haenszel or generic inverse‐variance method with fixed‐ or random‐effects meta‐analyses. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, physical health, cognitive function, quality of life and effect on medication regimen. Subgroup analyses were performed based on age and intervention types.ResultsA total of 259 studies (reported in 286 papers) were included in this updated review. Deprescribing polypharmacy did not result in a significant reduction in mortality in both randomized (OR 0.96, 95% confidence interval [CI] 0.84–1.09) and non‐randomized studies (OR 0.70, 95% CI 0.36–1.38). Further subgroup analyses of randomized studies on deprescribing polypharmacy demonstrated a significant reduction in mortality in the young old (aged 65–79) (OR 0.71, 95% CI 0.51–0.99) and when patient‐specific interventions were applied (OR 0.79, 95% CI 0.63–0.99).ConclusionsDeprescribing can be achieved with potentially important benefits in terms of improved survival, particularly when patient‐specific interventions are applied and initiated early in the young old.

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Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults

Cited by 4 publications

References 45 publications

Medication Optimization Protocol Efficacy for Geriatric Inpatients

Medication Optimization Protocol Efficacy for Geriatric Inpatients

Deprescribing in Dialysis: Operationalizing “Less is More” Through a Multimodal Deprescribing Intervention

The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis

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