Greater discontinuation

Pharmacist-led interventions could potentially reduce scripts for inappropriate medication in older adults, new research shows

An original investigation by Canadian pharmacy and medicine researchers set out to examine whether a pharmacist-led educational intervention could reduce inappropriate scripts among older people living in the community.

The D-PRESCRIBE (Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly) cluster randomised trial, published in JAMA this week, recruited community pharmacies in Quebec from February 2014 to September 2017, with follow-up until February 2018.

Pharmacies were randomly allocated to intervention or control groups.

Meanwhile the patients involved were aged 65 and over, and who were prescribed one of four Beers Criteria medicines: sedative-hypnotics, first-generation antihistamines, glyburide, or nonsteroidal anti-inflammatory drugs.

They were recruited from 69 community pharmacies.

“Pharmacists in the intervention group were encouraged to send patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion to recommend deprescribing,” the authors write in JAMA.

“The pharmacists in the control group provided usual care.

“Among 489 patients (mean age, 75 years; 66% women), 437 (89%) completed the trial (219 [88%] in the intervention group vs 218 [91%] in the control group),” they write.

“At six months, 106 of 248 patients (43%) in the intervention group no longer filled prescriptions for inappropriate medication compared with 29 of 241 (12%) in the control group (risk difference, 31% [95% CI, 23% to 38%]).

“In the intervention vs control group, discontinuation of inappropriate medication occurred among 63 of 146 sedative-hypnotic drug users (43.2%) vs 14 of 155 (9.0%), respectively (risk difference, 34% [95% CI, 25% to 43%]); 19 of 62 glyburide users (30.6%) vs 8 of 58 (13.8%), respectively (risk difference, 17% [95% CI, 2% to 31%]); and 19 of 33 nonsteroidal anti-inflammatory drug users (57.6%) vs 5 of 23 (21.7%), respectively (risk difference, 35% [95% CI, 10% to 55%]) (P for interaction = .09).

“Analysis of the antihistamine drug class was not possible because of the small sample size (n = 12). No adverse events requiring hospitalization were reported, although 29 of 77 patients (38%) who attempted to taper sedative-hypnotics reported withdrawal symptoms.”

The authors found that the intervention resulted in greater discontinuation of prescriptions for inappropriate medication after six months, compared to usual care.

However the generalisability of the findings to areas outside the Quebec setting require further research, they say.

See the full study here

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  1. John Wilks

    The (unsurprising) results from the D-PRESCRIBE (Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly) study re-affirm what has been known for 20 years – give suitably trained pharmacists access to patients who are the victims of prescribing cascading, poor regular reviews for relevant indications or patient confusion and we will deliver this result, every day. Indeed it is the raison d’etre for the establishment of the accredited pharmacist HMR/RMMR program. However, my ongoing sense of bewilderment and disappointment is that, despite dozens of papers showing the unarguable benefit of HMRs/RMMRs, this program is still restricted by a mandate of 20 patients per month per accredited pharmacist.

    This restriction is both lamentable and indefensible because the victim is the patient who cannot have access to a timely HMR.

    • Ex-Pharmacist

      John, one needs to understand a ‘pillar’ that exists in retail pharmacy in Australia.
      The pillar goes like this “All federal payments for medication related services to the public MUST be funnelled through a Section 90 pharmacy as defined in the National Health Act 1953.”

      It is explained in more detail here (and in comments that follow)

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