A medication review and deprescribing method for hospitalised older patients receiving multiple medications

摘要: Background Prescribing of multiple medications in older patients poses risk adverse drug events. Aim To determine whether a structured approach to deprescribing – identifying and discontinuing unnecessary the inpatient setting is feasible reduces medication burden. Methods Prospective pilot study convenience sample aged ≥65 years admitted acutely general medicine units tertiary hospital receiving eight or more regular on presentation. The intervention comprised an education programme paper-based computerised proforma listing clinical data linked with five-step decision support tool for selecting drugs eligible discontinuation, which were then ceased being weaned by time discharge. Results Among 50 median age 82.5 years six co-morbidities, 186 542 (34.3%) discontinued, representing significant decrease (interquartile range) number per patient at discharge compared presentation (7 (5–9) vs 10 (9–12), P < 0.001). Medication lists reduced least two 84% patients, four 50%. Statins, gastric acid suppressive agents, angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists inhaled bronchodilators most frequently medications. Of 39 whom follow-up status 78 days was ascertained, only 5 413 (1.2%) recommenced among three because symptom relapse. Conclusion A standardised method review may significantly reduce burden cohort hospitalised patients.