Pharmacist-initiated deprescribing in hospitalised elderly: prevalence and acceptance by physicians

Deprescribing can help reduce polypharmacy in the elderly and hospitalisation presents an opportunity to re-evaluate the use of medications. The aim of this study was to describe the drugs that were commonly suggested by pharmacists to be deprescribed in hospitalised elderly, and the factors associated with acceptance by physicians.

A retrospective, cross-sectional study was conducted in a tertiary hospital in Singapore. All pharmacist interventions on deprescribing in inpatient elderly aged ≥65 years, made between July and December 2015 were included. Comparisons between groups were made and independent factors associated with physician acceptance were determined.

A total of 503 interventions were included and 392 (77.9%) were accepted by physicians. Most interventions were on gastrointestinal agents (49.7%) and supplements (42.7%). The common reasons for deprescribing were: overduration of treatment (44.5%), unclear indication (23.9%) and the overdosage (20.7%). No significant differences were found between the reasons for deprescribing and acceptance by physicians. Use of <9 medications (OR 1.92, 95% CI 1.20 to 3.07), gastrointestinal agents (OR 3.46, 95% CI 1.06 to 11.26) and supplements (OR 3.20, 95% CI 1.06 to 9.69) were associated with higher physician acceptance (p<0.05).

In our cohort of hospitalised elderly, gastrointestinal agents and supplements were most commonly suggested by pharmacists to be deprescribed and at least three quarters of these interventions were accepted by physicians.