Background: Polypharmacy is associated with numerous adverse outcomes in the elderly. To date, deprescribing interventions have been implemented in the outpatient setting. We studied the effect of a structured hospital-based patient-centered deprescribing protocol on reducing total medication burden, including medications associated with geriatric syndromes.
Methods: We performed a single-center deprescribing pilot trial (Shed-Med) that was implemented among 20 intervention and 20 usual care control patients who were: age ≥ 65, receving ≥ 5 prescribed medications, and admitted to the hosptial with an intended skilled nursing facility (SNF) discharge. Shed-Med was based on a conceptual framework that considered multiple patient and disease factors. A patient preferences interview informed final deprescribing actions. The primary outcome was the total number of medications deprescribed from the number of medications at enrollment. Deprescribed was defined as termination or dose reduction of a medication. Enrollment medications reflected any medication that had the potential to be continued at hospital discharge to SNF. This included: a) pre-hospital medications and b) active in-hospital medications not on the pre-hospital medication list. We additionally compared reductions in medications associated with geriatric syndromes (MAGS), and reduction in a combined sedative / anticholinergic drug burden index (DBI). We used Mann-Whitney U Tests to compare the median number of deprescribed medications at discharge. We used linear regression, adjusting for enrollment medications, to quantify the intervention effect on reducing MAGS and the DBI.
Results: There was no statistically significant difference between groups in mean age, gender or Charlson comorbidity. The Shed-Med intervention and control group has similar number of medications at enrollment, 25.3 (± 6.4) and 23.4 (± 3.9), respectively. The number of pre-hospital medications in each group was 13.4 (± 4.8) and 15.4 (± 4.7), respectively. Table 1 shows the results of the intervention. The Shed-Med protocol compared to usual care significantly increased the median number of deprescribed medications at discharge and reduced the total medication burden. After adjustment, the intervention was associated with a reduction of a 1.9 (95% CI 0.5 to 3.2) MAGS and a 0.63 point (95% 0.8 to 1.2) reduction in the DBI.
Conclusions: A hospital-based patient-centered describing intervention successfully reduced the total burden of medications including PIMs and sedative/cholinergic drug burden. This protocol holds promise for reducing polypharmacy and improving patient safety in older hospitalized patients.