A Collaborative Medication Review Including Deprescribing for Older Patients in an Emergency Department: A...

Area of Science:

• Geriatrics
• Pharmacology
• Emergency Medicine

Background:

• Polypharmacy in older adults is a significant concern, increasing risks of adverse drug events and inappropriate prescribing.
• Emergency departments (EDs) are critical points for intervention, yet medication reviews for elderly patients with multiple medications are often overlooked.

Purpose of the Study:

• To evaluate the feasibility of a collaborative medication review for older medical patients (≥65 years) with polypharmacy (≥5 long-term medications) in the ED.
• To assess the impact of this intervention on medication appropriateness and underutilization.

Main Methods:

• A pharmacist conducted medication reviews using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, a drug-drug interaction database (SFINX), and a renal dosing database (Renbase®).
• A geriatrician reviewed the pharmacist's recommendations, deciding on implementation.
• Outcomes measured included changes in Medication Appropriateness Index (MAI) and Assessment of Underutilization Index (AOU) scores, and intervention completion rates before discharge.

Main Results:

• The intervention was completed before discharge for 83% of 60 included patients.
• Among 39 patients completing 30-day follow-up, the median MAI score significantly decreased from 14 at admission to 8 post-discharge (p < 0.001).
• The proportion of patients with an AOU score ≥1 decreased from 36% to 10% (p < 0.001), with 72% of patients having at least one medication deprescribed.

Conclusions:

• A collaborative medication review and deprescribing intervention is feasible and effective in the ED setting for older patients with polypharmacy.
• This approach successfully improves medication appropriateness and reduces medication burden, with sustained benefits at 30 days post-discharge.