Abstract
Objectives
Deprescribing has gained awareness recently, but the clinical benefits observed from
randomized trials are limited. The aim of this study was to examine the effectiveness
of a pharmacist-led 5-step team-care deprescribing intervention in nursing homes to
reduce falls (fall risks and fall rates). Secondary aims include reducing mortality,
number of hospitalized residents, pill burden, medication cost, and assessing the
deprescribing acceptance rate.
Design
Pragmatic multicenter stepped-wedge cluster randomized controlled trial.
Setting and Participants
Residents across 4 nursing homes in Singapore were included if they were aged 65 years
and above, and taking 5 or more medications.
Methods
The intervention involved a 5-step deprescribing intervention, which involved a multidisciplinary
team-care medication review with pharmacists, physicians, and nurses (in which pharmacists
discussed with other team members the feasibility of deprescribing and implementation
using the Beers and STOPP criteria) or to an active waitlist control for the first
3 months.
Results
Two hundred ninety-five residents from 4 nursing homes participated in the study from
February 2017 to March 2018. At 6 months, the deprescribing intervention did not reduce
falls. Subgroup analysis showed that intervention reduced fall risk scores within
the deprescribing-naïve group by 0.18 (P = .04). Intervention was associated with a reduction in mortality [hazard ratio (HR)
0.16, 95% confidence interval 0.07, 0.41; P < .001] and number of hospitalized residents (HR 0.16, 95% CI 0.10, 0.26; P < .001). Pre-post analysis witnessed a reduction in pill burden at the end of the
study, and a conservative daily cost saving estimate of US$11.42 (SG$15.65) for the
study population. Approximately three-quarters of deprescribing interventions initiated
by the pharmacists were accepted by the physicians.
Conclusions and Implications
Multidisciplinary medication review–directed deprescribing was associated with reductions
in mortality and number of hospitalized residents in nursing homes and should be considered
for all nursing home residents.
Keywords
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Article info
Publication history
Published online: May 15, 2020
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
