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Deprescribing as a Clinical Improvement Focus.

Thiruvinvamalai S Dharmarajan1, Hanbyul Choi1, Nadia Hossain1

  • 1Geriatric Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, NY.

Journal of the American Medical Directors Association
|November 2, 2019
PubMed
Summary

Deprescribing, the reduction of medications, was successful in 90.1% of geriatric patient encounters. This study highlights successful deprescribing rates and influencing factors in long-term care and outpatient settings.

Keywords:
Deprescribingadverse drug eventsdeprescribing as a performance improvement processdeprescriptionmedication discontinuationpolypharmacy

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Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacy
  • Healthcare Quality Improvement

Background:

  • Polypharmacy in geriatrics leads to adverse drug events and reduced quality of life.
  • Deprescribing, the systematic reduction of medications, is a strategy to address polypharmacy.
  • Challenges remain in the effective implementation of deprescribing in clinical practice.

Purpose of the Study:

  • To determine the success rate of deprescribing in geriatric patients.
  • To analyze deprescribing success by drug class and clinical setting.
  • To identify factors influencing the deprescribing process.

Main Methods:

  • A performance improvement project involving geriatric medicine fellows and faculty.
  • Deprescribing attempts were made during daily patient encounters in long-term care and outpatient clinics.
  • Patient or caregiver consent was obtained before initiating deprescribing.

Main Results:

  • Deprescribing was successful in 383 out of 449 encounters (90.1%).
  • Success rates were higher in long-term care (96.9%) compared to outpatient clinics (67.4%).
  • Analgesics, supplements, lipid-lowering agents, antihistamines, and acid blockers showed high deprescribing success.

Conclusions:

  • Deprescribing is feasible in both long-term care and outpatient settings.
  • Successful deprescribing is facilitated by provider effort and interdisciplinary collaboration.
  • Understanding and addressing barriers are crucial for effective deprescribing, potentially reducing adverse events and improving quality of life.