Abstract
Objectives
Perform a systematic review to evaluate the outcome of deprescription compared with
standard care. The focus was on chronic medical and mental health conditions managed
in primary care.
Design
The databases searched include PubMed, Medline, EMBASE, the Cochrane Library, Scopus,
and Web of Science. Each study was assessed for bias with the Cochrane Collaboration
tool.
Settings and Participants
This review included outpatient, assisted living, nursing home, and acute care settings
(if medications for chronic disease were deprescribed). Subjects were non–terminally
ill adults 18 years and older.
Measures
Primary outcome was successful deprescription, defined as a statistically significant
reduction in medication burden between the intervention group and the standard care
or control group, or when more than 50% of intervention subjects were able to tolerate
medication discontinuation compared with control by the end of the study.
Results
Fifty-eight articles met the study criteria. Thirty-three (58%) had a high risk of
bias. Studies varied in duration from 4 weeks to 5 years and were conducted across
a diverse array of primary health care settings. The most successful interventions
used pharmacist-led educational interventions and patient-specific drug recommendations.
Cardiovascular drugs including antihypertensives/diuretics and nitrates were the most
successfully deprescribed class of drugs. Psychotropic medications and proton-pump
inhibitors were the classes most resistant to deprescribing, despite intense intervention.
Conclusions/Implications
Deprescription may be successful and effective in select classes of drugs, with collaboration
of clinical pharmacists for patient and provider education, and patient-specific drug
recommendations, complemented by close clinical follow-up to detect early signs of
exacerbation of chronic diseases. This review also suggests that deprescription may
(1) require expensive intensive, ongoing interventions by clinical teams; (2) not
lead to expected outcomes such as improved falls rate, cognition, and quality of life,
or a lower admission rate; and (3) have unexpected adverse outcomes affecting patients’
quality of life.
Keywords
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Article info
Publication history
Published online: August 11, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
