Authors (including presenting author) :
CHOI HTN(1), YOUNG WM(1), CHU LM(1), LI KL(1), Chau M(1), WONG KT(1), AU YUENG TW(2), CHAN NH(2), TSE CM(2), FONG YL(3)
Affiliation :
(1)Pharmacy Department, New Territories West Cluster (2)Department of Medicine and Geriatrics, Pok Oi Hospital (3)Specialist Out-patient Department, Pok Oi Hospital
Introduction :
Inappropriate prescribing and polypharmacy in elderlies are associated with increased risks of adverse drug events, falls, and hospital admissions. Medication optimization through deprescribing can reduce drug burden, enhance medication safety and improve patient outcomes.
Objectives :
This geriatrician-pharmacist collaborative medication deprescribing program aimed to address the problem of polypharmacy in Medicine and Geriatrics(MG) Clinic in Pok Oi Hospital(POH). Outcomes of deprescribing plans recommended by pharmacists were evaluated, including acceptance by doctors, and tolerability and acceptance by patients and/or carers.
Methodology :
Targeted patients were aged above 60 and prescribed with at least 8 medications from POH MG Clinic. Two weeks before the MG consultation, pharmacist would review patient notes and carry out telephone assessment on patient’s drug taking behaviour, pharmacist would then propose a deprescribing plan to geriatricians prior to consultation if needed. A pharmacist counselling session on drug changes would be provided for patient and/or carers after geriatricians deprescribed the medications. To ensure tolerability and compliance to the deprescribed regimen, telephone follow-up would be performed at week-1 and week-8 post consultation.
Result & Outcome :
67 cases were reviewed by pharmacists from 7-Jul to 29-Sep-2020 and 192 recommendations were made(2.9 recommendations/case). 43 out of 51 cases seen by geriatrician had at least 1 recommendation accepted(84%). Recommendations were mainly to discontinue an inappropriate drug(n=49), and reduce excessive drug dosage or frequency(n=50), with 35(71%) and 31(62%) acceptances respectively. The average number of prescribed medicine decreased from 12.2 to 9.3 among patients with drugs discontinued, with the most significant reduction from 12 to 6 drugs in one case. All patients appreciated the drug changes and tolerated new regimens well at the week-1 telephone follow-ups. Upon case review at week-8, no patient was hospitalized or had extra doctor visit due to the new deprescribed regimen.
In conclusion, 84% patients had at least 1 recommendation accepted by geriatricians, and regimens after deprescribing were welcomed and well tolerated by all patients. Communication and collaboration with patient, geriatricians and pharmacists are essential for the success of Deprescribing program so as to maintain the best quality of life and maximize the benefit of medication to patients.
