Pharmacist-led medication assessment and deprescribing intervention for older adults with cancer and polypharmacy: a pilot study

Abstract

Purpose The aims of this study were to compare the application of three geriatric medication screening tools to the Beers Criteria alone for potentially inappropriate medication quantification and to determine feasibility of a pharmacist-led polypharmacy assessment in a geriatric oncology clinic. Methods Adult patients with cancer aged 65 and older underwent a Comprehensive Geriatric Assessment. A polypharmacy assessment was completed by a pharmacist and included a review of all drug therapies. Potentially inappropriate medications were screened using the Beers Criteria, Screening Tool to Alert doctors to Right Treatment / Screening Tool of Older Persons’ Prescriptions, and the Medication Appropriateness Index. Deprescribing occurred after discussion with the pharmacist, geriatric oncologist, patient, and caregiver. Results Data were collected for 26 patients. The mean number of medications was 12. The Beers Criteria alone identified 38 potentially inappropriate medications compared to 119 potentially inappropriate medications with the three tool assessment; a mean of 5 potentially inappropriate medications were identified per patient. After the application of the three tool assessment, 73% of potentially inappropriate medications identified were deprescribed, resulting in a mean of 3 medications deprescribed per patient. Approximately two-thirds of patients reported a reduction in symptoms after the deprescribing intervention. Healthcare expenditures of $4,282.27 per patient were potentially avoided as a result of deprescribing. Conclusions Our three tool assessment identified three times more potentially inappropriate medications than the Beers Criteria alone. Pharmacist-led deprescribing interventions are feasible and may lead to improved patient outcomes and cost savings. This three tool assessment process should be incorporated into interdisciplinary assessments of older patients with cancer and validated in future studies.

Barriers to Effective Prescribing in Older Adults: Applying the Theoretical Domains Framework in the Ambulatory Setting

“…Moving forward, the study team will take ndings from this scoping review into a modi ed Delphi study to explore the signi cance of the identi ed TDF domains in Singapore's context, bearing in mind the potential for cultural and healthcare framework differences between Singapore and the studies included in this review. Building upon empiric evidence for pharmacist involvement in medication reviews, which has demonstrated improvements in prescribing practices and reduction in PIP [61][62][63][64] , our ultimate aim as a study team would be to develop a physician-pharmacist collaborative care intervention to guide effective prescribing for the older adults in the ambulatory setting.…”

Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting – a scoping review

“…Moving forward, the study team will take findings from this scoping review into a modified Delphi study to explore the significance of the identified TDF domains in Singapore’s context, bearing in mind the potential for cultural and healthcare framework differences between Singapore and the studies included in this review. Building upon empiric evidence for pharmacist involvement in medication reviews, which has demonstrated improvements in prescribing practices and reduction in PIP [ 60 – 63 ], our ultimate aim as a study team would be to develop a physician-pharmacist collaborative care intervention to guide effective prescribing for the older adults in the ambulatory setting.…”

Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults

“…First, our results address an underinvestigated area that contributes to mortality in older allo-HCT patients. Second, the identification of potentially modifiable risk factors suggests that all older patients should benefit from pretransplant geriatric assessment and targeted interventions such as a pharmacist-led medication review, 46,47 pre-habilitation, and peritransplant delirium and fall prevention strategies. 32,37,43,48,49 We summarize potential prevention and intervention strategies in supplemental Table 4.…”