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Reducing inappropriate polypharmacy: the process of deprescribing.
Ian A Scott1, Sarah N Hilmer2, Emily Reeve3
1Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Australia2School of Medicine, University of Queensland, Brisbane, Australia.
JAMA Internal Medicine
|March 24, 2015
Summary
Deprescribing, the process of stopping medications, helps reduce inappropriate polypharmacy and adverse drug events in older adults. Following a structured 5-step protocol can improve patient outcomes by minimizing drug burden.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacology
- Patient Safety
Background:
- Inappropriate polypharmacy in older adults leads to significant adverse drug events, morbidity, and mortality.
- The number of prescribed drugs is a key predictor of prescribing errors and adverse drug events in elderly patients.
Purpose of the Study:
- To introduce and detail a structured 5-step protocol for deprescribing.
- To highlight the importance of deprescribing in managing polypharmacy and improving patient outcomes.
Main Methods:
- The proposed protocol involves: 1. Ascertaining all current medications and indications. 2. Assessing individual patient risk for drug-induced harm. 3. Evaluating the benefit-harm potential of each drug. 4. Prioritizing drugs with low benefit-harm ratios for discontinuation. 5. Implementing a discontinuation plan with close patient monitoring.
Main Results:
- Emerging evidence from trials and observational studies supports the efficacy of deprescribing.
- The protocol provides a systematic approach to reduce drug burden and associated risks.
Conclusions:
- Deprescribing is a crucial strategy for mitigating the harms of polypharmacy in older adults.
- Despite existing barriers, available resources and strategies can facilitate effective deprescribing, warranting wider implementation.
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