Reducing post-discharge potentially inappropriate medications amongst the elderly: a multi-centre electronic deprescribing intervention
This 16-week pilot study evaluated the impact of MedStopper, a previously developed electronic deprescribing tool, on reduction of potentially inappropriate medications (PIMs) as compared to usual care.
Possible Research Results
Anticipated findings: We anticipate that MedStopper will reduce inappropriate medication use and that results from this preliminary study will help us to adapt the tool for a larger national study powered to reduce adverse drug events.
Impact of findings: Findings could be the first step to incorporating deprescribing as a part of standard care upon discharge from hospital. These findings should inform best practices in frail elderly patients with polypharmacy and ultimately decrease the burden and cost of potentially inappropriate medications and their associated complications. If successful, this could lead to a reduction of several thousand hospitalizations annually, across Canada.
Read more about the project’s impact here.
About the Project
Polypharmacy, or the concomitant use of five or more drugs, is a serious health concern affecting more than half of Canadians aged 65 years and older. Medications can be essential, but each additional one increases the risk of an adverse drug event (ADE). Polypharmacy is the number one identifiable risk factor for ADEs and Canada’s 1.1 million frail older adults are especially at risk. ADEs are responsible for nearly 27,000 hospital admissions annually in Canada and up to 20% of return visits to the hospital within 30 days of discharge. Many ADEs could be preventable or ameliorable through interventions to reduce inappropriate prescribing.
Our intervention adapted MedStopper in order to automate the process of deprescribing. At the time of hospitalization, the patient’s medications and comorbidities, along with a measure of frailty, were entered into MedStopper, which generated an individualized, prioritized, deprescription plan targeting PIMs. The most responsible physician could then choose to implement the deprescribing plan after discussion with the patient/caregiver.
Todd Campbell Lee, MD, MPH, FRCPC — McGill University Health Centre
Emily McDonald, MD, MSc — McGill University Health Centre
James Downar, MDCM, MHSc, FRCPC — Toronto General Hospital, University Health Network
Alan Forster, MD, MSc, FRCPC — Ottawa Hospital
Allen Huang, MDCM, FACP, FRCPC — Ottawa Hospital
Louise Pilote, MD, PhD, MPH — McGill University
Robyn Tamblyn, PhD — McGill University
Knowledge Users and Partners:
Janice Carr, PharmD
Project Contact: Todd Lee — firstname.lastname@example.org
Rationale: Deprescribing can require substantial time and resources. An easy-to-use and effective tool is needed to help doctors and pharmacists quickly identify potentially inappropriate medications for stopping, especially in the case of patients with multiple or complex medical conditions.
Hypothesis: We hypothesize that amongst hospitalized medical patients, our electronic tool (MedStopper), will alert doctors to potentially inappropriate medications and will result in fewer inappropriate prescriptions compared to usual care.
Objectives: To determine whether MedStopper can reduce prescriptions for potentially inappropriate medications, sustained at 30 days post discharge from the hospital. We will also evaluate how the intervention impacts adverse drug events and quality of life.
Research plan: This study will run at the McGill University Health Centre, the Ottawa Hospital, and the Toronto General Hospital. Participants will be hospitalized adults aged 65 years and older. Each hospital will undergo a control phase followed by an intervention phase where MedStopper will be implemented.