title: A medication review and deprescribing method for hospitalised older patients receiving multiple medications.
abstract: BACKGROUND
  Prescribing of multiple medications in older patients poses risk of adverse drug events.
  
  
  OBJECTIVE
  To determine whether a structured approach to deprescribing - identifying and discontinuing unnecessary medications - in the inpatient setting is feasible and reduces medication burden.
  
  
  METHODS
  Prospective pilot study of a convenience sample of patients aged ≥65 years admitted acutely to general medicine units in a tertiary hospital and receiving eight or more regular medications on presentation. The intervention comprised an education programme and a paper-based or computerised proforma listing clinical and medication data linked with a five-step decision support tool for selecting drugs eligible for discontinuation, which were then ceased or were being weaned by the time of discharge.
  
  
  RESULTS
  Among 50 patients of median age 82.5 years and six co-morbidities, 186 of 542 (34.3%) regular medications were discontinued, representing a significant decrease in the median (interquartile range) number of medications per patient at discharge compared with presentation (7 (5-9) vs 10 (9-12), P < 0.001). Medication lists were reduced by at least two medications in 84% of patients, and by four or more in 50%. Statins, gastric acid suppressive agents, angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists and inhaled bronchodilators were the most frequently ceased medications. Of 39 patients in whom follow-up status at a median of 78 days was ascertained, only 5 of 413 (1.2%) ceased medications were recommenced among three patients because of symptom relapse.
  
  
  CONCLUSIONS
  A standardised method of medication review and deprescribing may significantly reduce medication burden in a cohort of older hospitalised patients.
authors.affiliation: Advanced Trainee General Medicine, Ipswich Hospital, Ipswich.
authors.forename: M
authors.initials: M
authors.lastname: McKean
authors.affiliation: Clinical Pharmacology, Princess Alexandra Hospital, Harlow, UK.
authors.forename: P
authors.initials: P
authors.lastname: Pillans
authors.affiliation: Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital.|School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: I A
authors.initials: IA
authors.lastname: Scott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000069340:Deprescriptions; D017723:Drug Utilization Review / Q000379:methods* / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000639:trends; D008297:Male; D010351:Patient Discharge / Q000639:trends; D010865:Pilot Projects; D019338:Polypharmacy; D011446:Prospective Studies
keywords: deprescribing; medication; older patient; review