The study funded by Canadian Institutes of Health Research showed that a pharmacist-led educational intervention resulted in greater discontinuation of inappropriate prescriptions compared with usual care after 6 months.
Key Points
Question: Can a consumer-targeted, pharmacist-led educational intervention reduce prescriptions for inappropriate medication among community-dwelling older adults?
Findings: In this cluster randomized trial that included 489 older adults, the percentage achieving discontinuation of a targeted inappropriate prescription at 6 months was 43% among patients receiving the intervention vs 12% receiving usual care, which represents a significant difference.
Meaning: A pharmacist-led intervention has the potential to reduce prescriptions for inappropriate medication in older adults.
Introduction
Inappropriate prescriptions continue to be frequently dispensed to older adults. It has been estimated that 29.0% of Medicare beneficiaries aged 65 years and older in the United States in 2015 and 31.1% of older adults in Canada in 2016 filled a prescription for at least 1 medication included in the 2015 American Geriatrics Society Beers Criteria list of drugs to avoid in older adults. Labelled as inappropriate because of the risk of harm and availability of safer treatments, inappropriate prescriptions can lead to adverse drug events, falls, cognitive impairment, and emergency hospitalizations.
Deprescribing is the act of reducing or stopping medication that is no longer necessary or that may cause harm. Primary care physicians express a lack of time, poor awareness of the harms of medications, and fear of withdrawal symptoms or patient criticism as barriers to deprescribing. Pharmacists can assist physicians in optimizing medication management in older adults. Medication reviews by a pharmacist followed by direct communication to the prescribing physician have been shown to result in safer prescribing practices. Patients can also initiate the deprescribing process. In a randomized clinical trial of 303 long-term users of benzodiazepine medications, providing education about the risks of benzodiazepine use compared with providing usual care resulted in an additional 23% of patients discontinuing their medication within 6 months. Patients who elected not to taper their medication cited physician or pharmacist discouragement as the major impediment. Streamlining communication and deprescribing efforts among patients, physicians, and pharmacists may augment shared accountability for safer prescribing while maintaining patient trust.
The objective of the D-PRESCRIBE (Developing Pharmacist-led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly) cluster randomized trial was to determine the effectiveness of a pharmacist-led intervention to educate older adults and their physicians about reducing inappropriate prescriptions.
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