Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study

Area of Science:

• Nephrology
• Pharmacology
• Health Informatics

Background:

• Patients on dialysis often take multiple medications (polypharmacy), increasing the risk of medication harm from potentially inappropriate medications (PIMs).
• Deprescribing, the process of stopping or reducing medications, is a strategy to mitigate this risk but can be complex.
• The effectiveness of clinical decision support (CDS) tools in facilitating deprescribing for dialysis patients remains unclear.

Purpose of the Study:

• To evaluate the efficacy of the MedSafer CDS software in increasing deprescribing among patients undergoing dialysis.
• To assess the impact of MedSafer combined with patient educational materials on PIM reduction.

Main Methods:

• A prospective, controlled quality improvement study was conducted in two outpatient dialysis units.
• The intervention unit utilized MedSafer to identify PIMs during medication reviews, providing reports to nephrologists and educational brochures (EMPOWER) to patients.
• The control unit received usual care without the CDS intervention.

Main Results:

• The proportion of patients with at least one PIM deprescribed was significantly higher in the intervention unit (39.7%) compared to the control unit (3.1%).
• This represents an absolute risk difference of 36.6% (P < 0.0001), with a number needed to treat of 3.
• Secondary outcomes showed a reduction in the mean number of prescribed drugs and PIMs in the intervention group.

Conclusions:

• The MedSafer CDS tool, alongside patient education, is an effective and potentially scalable intervention for addressing PIMs in the dialysis population.
• Further research, including a randomized controlled trial, is warranted to confirm these findings and assess long-term outcomes.
• This approach holds promise for improving medication safety and reducing adverse drug events in patients treated with dialysis.