A randomized multi-centre trial first published online in January in JAMA (Journal of the American Medical Association) Internal Medicine, shows how personalized deprescribing reports generated automatically during an inpatient stay can reduce an individual’s dependency on multiple medications.
Led by researchers at McGill University, and supported by UHN specialists from both General Internal Medicine (GIM) and Pharmacy, the study involved 5,698 hospitalized participants at 11 Canadian acute care hospitals between August 2017 and January 2020.
The study’s main objective was to determine whether deprescribing – the planned and supervised process of dose reduction or stopping medication that might be causing harm, or might no longer be of benefit – had an effect on adverse-drug events (ADEs) among older patients within 30 days of discharge.
While this decision support had little effect on ADEs, it did have a significant impact on polypharmacy, which is defined as the regular use of five or more medications, a common practice among older adults.
“Excess medication and polypharmacy is an important issue, particularly for our aging population,” says Dr. Peter Wu, staff internist, GIM, UHN and a co-author of the study. “However, ‘deprescribing,’ or stopping drugs is very difficult for patients to do on their own, whether because of inertia, fear of rebound side effects, or that they do not want to stop.”
The study, which was also co-authored by UHN GIM physicians Dr. Rodrigo Cavalcanti and Dr. Thomas MacMillan, and pharmacist Dr. Kiran Battu, found that a hospital admission provided an opportunity to approach patients about polypharmacy and support them in desprescribing, where appropriate.
Study participants were given personalized reports containing deprescribing opportunities generated using the software MedSafer. These reports addressed usual home medications, incorporated measures of prognosis and frailty, and were then provided to the treating team who would compare them to the in-hospital care for medication reconciliation.
“What we have found was that patients are quite keen to stop taking multiple medications and are grateful that GIM physicians are looking at this during their admission,” says Dr. Cavalcanti. “Furthermore, this is a simple intervention that can be rather seamlessly introduced into the regular workflow with the benefit that it helps to stop unnecessary drugs in older adults and reduces pill burden.
“It’s a great example of GIM leading research in areas that matter for patients implemented at both Toronto General Hospital and Toronto Western Hospital, and across Canada,” he adds.
The research is still helpful to reduce ADEs as it helps to inform future work either to look farther than 30 days to detect benefit, or to expand this intervention to include safely stopping high-risk drugs.