How to implement deprescribing into clinical practice

Abstract

We currently live in the age of medication overload. More than 40% of older adults (≥65 years old) are prescribed ≥5 medications a day and nearly 20% take ≥10.Although medications can provide a wide variety of benefits, the number of medications prescribed is the largest predictor of drug-drug interactions, nonadherence, and most importantly adverse drug events. Increasingly, patients, caregivers, and health care providers are employing deprescribing efforts as a solution to medication overload. Clinical pharmacists are well positioned to lead and/or contribute to deprescribing efforts. Deprescribing, however, is not commonly and consistently taught within the United States health professional curriculums, and deprescribing infrastructure support is currently limited. The goal of this review is to present a pragmatic approach to pharmacist-driven clinical practice deprescribing implementation.

Deprescribing: A Prime Opportunity to Optimize Care of Cancer Patients

“…While barriers have been identified in the literature, several facilitators at the patient, caregiver, provider, and organizational levels can be leveraged when exploring potential medication cessation with patients [44]. Examples of patient facilitators include medication burden, psychological benefit of medication cessation, and overall distaste in medication [44].…”

“…While barriers have been identified in the literature, several facilitators at the patient, caregiver, provider, and organizational levels can be leveraged when exploring potential medication cessation with patients [44]. Examples of patient facilitators include medication burden, psychological benefit of medication cessation, and overall distaste in medication [44]. Identification of such facilitators can aid providers in initiating deprescribing discussions and further elicit their patients' values and understanding of their overall health and care goals [44].…”

“…Examples of patient facilitators include medication burden, psychological benefit of medication cessation, and overall distaste in medication [44]. Identification of such facilitators can aid providers in initiating deprescribing discussions and further elicit their patients' values and understanding of their overall health and care goals [44]. Table 3 outlines facilitators and barriers to deprescribing [44].…”

Education Standards for Pharmacists Providing Comprehensive Medication Management in Outpatient Nephrology Settings

“…Deprescribing is addressed as a separate education standard (II-5) since processes to facilitate deprescribing have been developed in the CKD population to reduce medication burden and/or prevent harm. 27 , 28 , 29 , 30 , 31 Deprescribing is the planned and supervised process of discontinuing medications that may cause harm or are no longer of benefit and may help to minimize use of potential nephrotoxic agents as well as those that may cause harm. The increased susceptibility of older individuals with advanced kidney disease to medication therapy problems prompted a separate education standard to focus on unique consideration to prevent such medication therapy problems in the geriatric population with kidney disease (II-6).…”

Polypharmazie

“…Die Notwendigkeit der Medikamente sollte grundsätzlich kritisch hinterfragt werden. Bei bestimmten Medikamentengruppen lohnt es sich besonders, genauer hinzusehen und das kritische Reviewing durchzuführen -> s. nachfolgende Tabelle 1 [15,18]): Bei der strukturierten Evaluierung kann der (modifizierte) Medication Appropriateness Index (MAI) herangezogen werden (siehe Anhang 5.1). Dieser ist allerdings sehr umfassend und deshalb wenig praktikabel.…”