Deprescribing Through the LESS-CHRON Tool: Recruitment Data and Results of Impact on Pharmacological Treatment...

Deprescribing is a key strategy for optimizing therapeutic plans in multimorbid or complex chronic patients. Despite its long-standing use, further studies are needed to validate health outcomes and support its routine clinical integration. This project aims to assess the impact of applying LESS-CHRON criteria in terms of therapeutic and anticholinergic burden, as well as to describe potentially inappropriate medications (PIMs) more often involved in chronic treatments of patients with multimorbidity or those with complex health needs across two care settings: institutionalized and outpatients.

A quasi-experimental, multicenter, pre-post intervention cohort study was conducted in several phases (screening, intervention, and follow-up at 3 and 6 months after inclusion). The study included two cohorts: outpatients and institutionalized patients. The main variable was the percentage reduction in medication use. Additionally, the deprescribing success rate, reasons for non-acceptance (barriers to deprescribing), anticholinergic burden, and non-pharmacological variables were analyzed.

Four hundred and sixty patients (229 outpatients, 231 institutionalized) with a mean age of 84.5 (SD: 7.9) years were included. Demographic, clinical, and pharmacological data were collected. Deprescribing opportunities were identified using the LESS-CHRON criteria, and recommendations were assessed by medical teams. Follow-up evaluations were conducted after 3 months. A total of 960 PIMs were identified, of which 542 medications were successfully deprescribed (345 patients), with an acceptance rate of 56.46%, showing no significant differences between cohorts. The overall therapeutic burden was reduced by 10.73% (SD: 10.68). The main barriers to deprescribing were clinical decisions (69.86%) and patient/family refusal (11.72%). After 3 months, at least one deprescribed drug was reintroduced in 61 patients. The mean deprescribing success rate was 87.10%, which was significantly higher in institutionalized patients (p < 0.05), and the anticholinergic burden was significantly reduced (p < 0.001).

The LESS-CHRON tool effectively identified deprescribing opportunities, reducing both medication burden and anticholinergic load. Institutionalized patients had a higher deprescribing success rate. However, clinical judgment and patient preferences remain key barriers to successful implementation.