Compared with usual care, a deprescribing intervention led to fewer medications at discharge and at 90 days.

Hospitalised patients often are discharged on a long list of medications – some of them unnecessary. In this randomised trial, researchers determined the effects of a deprescribing intervention among 284 hospitalised adults (age, 50 years and older; mean age, 77 years) who were taking five or more prehospital medications (over-the-counter or prescription) and who were discharged to postacute care facilities. The intervention group received a pharmacist- or nurse practitioner-led medication review during hospitalisation and postacute care facility stay. The control group had usual care.

Compared with controls, patients in the intervention group took significantly fewer medications at discharge from a postacute care facility (15 vs 13 medica­tions) and fewer medications at 90 days’ follow up (14 vs 12 medications). Similar results were obtained when over-the-counter medications were excluded. The intervention also resulted in significantly fewer potentially inappropriate medica­tions and lower Drug Burden Index at discharge from a postacute care facility and at 90 days’ follow up. Adverse drugs events were similar in both groups. Drugs with especially noteworthy differences in deprescribing between intervention and control patients included vitamins and supplements, laxatives, antihypertensive drugs, anticoagulants, diabetes drugs and proton-pump inhibitors.

Comment: These results add to growing evidence that medication deprescribing for hospitalised older adults is feasible and safe, but it requires time, effort and per­sonnel. This study involved a pharmacist- or nurse practitioner-led intervention; it would be interesting to examine whether physician-led interven­tions could reduce polypharmacy even further.

Paul S. Mueller, MD, MPH, FACP
Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.

Vasilevskis EE, et al. Deprescribing medications among older adults from end of hospitalization through postacute care: a Shed-MEDS randomized clinical trial. JAMA Intern Med 2023; 183: 223-231.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine