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Targeted Deprescribing in an Outpatient Hemodialysis Unit: A Quality Improvement Study to Decrease Polypharmacy.

Caitlin McIntyre1, Rory McQuillan2, Chaim Bell3

  • 1Department of Pharmacy, University Health Network, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|April 19, 2017
PubMed
Summary

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This summary is machine-generated.

A new deprescribing tool effectively reduced polypharmacy in hemodialysis patients. The study demonstrated successful medication reduction without compromising patient safety or satisfaction.

Area of Science:

  • Nephrology
  • Pharmacology
  • Quality Improvement

Background:

  • Polypharmacy is prevalent in hemodialysis patients, increasing the risk of adverse outcomes.
  • Existing deprescribing tools lack applicability in outpatient hemodialysis settings.

Purpose of the Study:

  • To develop and implement a deprescribing tool for hemodialysis patients.
  • To evaluate the tool's effectiveness in reducing polypharmacy.
  • To monitor patient safety and satisfaction during the deprescribing process.

Main Methods:

  • A quality improvement study was conducted in a tertiary-care outpatient hemodialysis unit.
  • A deprescribing tool was developed for 5 medication classes with questionable efficacy/safety.
  • 240 patients were screened, and the tool was applied to eligible patients.
Keywords:
Deprescribingelderlyend-stage renal disease (ESRD)hemodialysis (HD)medication optimizationmedication prescribing patternsoutpatient HDpatient safetypill burdenpolypharmacypotentially inappropriate medicationsquality improvement activity

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Main Results:

  • The deprescribing tool was successfully implemented, with 88% of eligible patients having target medications deprescribed.
  • At 6 months, only 16% of discontinued medications were re-prescribed.
  • 57% of patients were taking fewer medications post-intervention, with no observed adverse events.

Conclusions:

  • Deprescribing tools are feasible and effective in outpatient hemodialysis units.
  • This approach can significantly reduce polypharmacy.
  • Patient safety and satisfaction were maintained throughout the intervention.