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Retrospective analysis of a pilot pharmacist‐led hospice deprescribing program initiative
Author(s) -
Le Vy,
Patel Neerali,
Nguyen Quyen,
Woldu Henock,
Nguyen Lily,
Lee Ava,
Deguzman Lynn,
Krishnaswami Ashok
Publication year - 2021
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.17122
Subject(s) - deprescribing , medicine , polypharmacy , pharmacist , beers criteria , retrospective cohort study , context (archaeology) , odds ratio , palliative care , medical prescription , life expectancy , medication therapy management , emergency medicine , family medicine , pharmacy , intensive care medicine , nursing , population , paleontology , environmental health , biology
Context Medication deprescribing in palliative care settings has been insufficiently studied. Objective To determine the feasibility of a deprescribing program in hospice patients with limited life expectancy. Design Pharmacist‐led, single arm, single‐centered, retrospective analysis of a pilot deprescribing program in an integrated healthcare delivery organization between 9/1/2018 to 1/31/2019. Outcome measures The primary outcome was the proportion of patients who achieved ≥50% reduction of the recommended medications to deprescribe. Results A total of 97 patients were included in the analysis. The average age was 77.5 ± 23.7 years, with 53.6% being women and 54.6% white. The most common primary diagnosis was cancer (58.8%), with cardiovascular disease the next most common (15.5%). The mean number of baseline comorbidities was 2.0 ± 1.6. Of 698 prescriptions at the start of hospice enrollment, 79.4% of patients achieved a ≥50% reduction in medications recommended for deprescribing. This success was seen mostly in cardiovascular and other nonspecific medications. We found that every 1‐unit increase in the number of patient encounters with hospice pharmacists was associated with a 3.2‐fold higher odds of achieving a ≥50% reduction in medications that were recommended for deprescribing. Conclusion The findings from this pilot study revealed that a collaborative, pharmacist‐led, collaborative medication deprescribing program initiative was associated with a 79% success in ≥50% medication reduction. More frequent patient encounters had higher odds of success. Future studies, utilizing a control group, should focus on determining the effectiveness of the program and the impact on quality of life.