Retrospective analysis of a pilot pharmacist-led hospice deprescribing program initiative.

Autor: Le V; Division of Pharmacy, Kaiser Permanente San Jose Medical Center, San Jose, California, United States., Patel N; Division of Pharmacy, Kaiser Permanente San Jose Medical Center, San Jose, California, United States., Nguyen Q; Division of Pharmacy, Kaiser Permanente San Jose Medical Center, San Jose, California, United States., Woldu H; Division of Pharmacy, Kaiser Permanente San Jose Medical Center, San Jose, California, United States., Nguyen L; Division of Pharmacy, Kaiser Permanente San Jose Medical Center, San Jose, California, United States., Lee A; Division of Hospice and Palliative Care, Kaiser Permanente San Jose Medical Center, San Jose, California, USA., Deguzman L; Kaiser Permanente, Regional Office, Oakland, California, USA., Krishnaswami A; Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2021 May; Vol. 69 (5), pp. 1370-1376. Date of Electronic Publication: 2021 Mar 26.
DOI: 10.1111/jgs.17122
Abstrakt: 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.
(© 2021 The American Geriatrics Society.)
Databáze: MEDLINE
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