Authors (including presenting author) :
Dr WONG SK (1), Dr KO SH (1), Dr CHAN KH (1), Dr LI YC (1), Dr CHEN XR Catherine (1)
Affiliation :
(1) Department of Family Medicine and General Out-patient Clinic, Queen Elizabeth Hospital
Introduction :
Hong Kong's population has experienced an aging trend since the early 2000s. Polypharmacy, defined by taking 5 or more drugs continuously over the last 6 weeks, is a common phenomenon among older people and is expected to become a major health concern in the coming years. Polypharmacy has been shown to adversely affect the elderly in multiple aspects. Given its high prevalence and the potential detrimental effect of polypharmacy among the elderly, the need to optimizing the drug regimen of elderly patients with polypharmacy is ever pressing. Deprescribing is the process of trial withdrawal of inappropriate medications, with the goal of managing polypharmacy and improving the clinical outcomes.
Objectives :
To explore the clinical effectiveness of Deprescription Clinic (DPC) among Chinese elderly patients with polypharmacy in the primary care and to evaluate its impact on the functional capacity and quality of life.
Methodology :
Design:
Quasi-experimental design study.
Subjects:
245 Chinese elderly patients with polypharmacy who had been regularly followed up at DPC of Yau Ma Tei Jockey Club Clinic from 1 February 2017 to 30 June 2018. Polypharmacy is defined as taking more than 10 medications in total among which at least 5 were chronic medications.
Main Outcome Measures:
Measurements were assessed at baseline and 12-month interval. The primary outcome is the total number of prescribed chronic drug items per day, total number of chronic drug pills prescribed per day and frequency of chronic drug intake per day. The Secondary outcome includes chronic disease control status, quality of life (QOL), independence in activities of daily living (ADL), risk of fall, cognitive function and Accident and Emergency Department (AED) attendance.
Result & Outcome :
After medication review and management at DPC for 12-months, all 3 primary outcomes showed statistically significant reduction (all p-value < 0.001). The chronic disease control was stable after management in DPC. There was statistically significant improvement in a few domains of QOL. The risk of fall was reduced whereas the ADL, cognitive function and AED attendance were not affected.
Conclusions:
DPC is effective in reducing the number of inappropriate chronic medication use among Chinese elderly patients with polypharmacy, without affecting the chronic disease control. It can also improve the QOL and reduce the risk of fall in this group of patients.
