Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls.

Autor: Pavon JM; Department of Medicine/Division of Geriatrics, Duke University, Durham, North Carolina, USA.; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center.; Duke University Claude D. Pepper Center, Durham, North Carolina, USA., Davidson S; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center., Sloane R; Department of Medicine/Division of Geriatrics, Duke University, Durham, North Carolina, USA.; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center.; Duke University Claude D. Pepper Center, Durham, North Carolina, USA., Pepin M; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center., Bryan W; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center., Bailey J; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center., Igwe I; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center., Colon-Emeric C; Department of Medicine/Division of Geriatrics, Duke University, Durham, North Carolina, USA.; Durham Veteran Affairs Health Care System, Geriatric Research Education Clinical Center.; Duke University Claude D. Pepper Center, Durham, North Carolina, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Feb; Vol. 72 (2), pp. 433-443. Date of Electronic Publication: 2023 Nov 08.
DOI: 10.1111/jgs.18650
Abstrakt: Background: Falls are the most common medication-related safety event in older adults. Deprescribing fall risk-increasing drugs (FRIDs) may mitigate fall risk. This study assesses the effects of an innovative deprescribing program in reducing FRID burden and falls-related acute visits over 1 year.
Methods: The Falls Assessment of Medications in the Elderly (FAME) Program is a pilot deprescribing program designed to improve medication safety in Veterans aged ≥65, screening positive for high fall risk at the Durham Veterans Affairs Health Care System. Central case finding and electronic case reviews with deprescribing recommendations were completed by an interdisciplinary team, forwarded to prescribers for approval, then implemented during follow-up telephone visits by FAME team. Primary outcome was change in FRID burden calculated by modified Drug Burden Index (DBI) at 1 year and an exploratory outcome was 1-year fall-related acute visits.
Results: Overall, 472 patients (236 intervention cases, 236 matched controls) were included in the study. Of the 236 patients receiving a FAME deprescribing plan, 147 had recommendations approved by prescriber and patient. In the intention-to-treat analysis, the 1-year change in modified DBI was -0.15 (95% CI -0.23, -0.08) in the intervention cohort and -0.11 (-0.21, -0.00) in the matched control cohort (p = 0.47). The odds of increasing DBI by a clinically important threshold of 0.5 was significantly lower in the FAME cohort (OR 0.37, 0.21, 0.66). Fall-related acute events occurred in 6.3% of patients in the intervention group versus 11.0% in control patients over a one-year period (p = 0.10).
Conclusions: The program was associated with a significantly lower odds of further increasing FRID burden at 1 year compared to matched controls. An electronic case review and telephone counseling program has the potential to reduce drug-related falls in high-risk older adults.
(© 2023 The American Geriatrics Society.)
Databáze: MEDLINE
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