Is the Clinical pharmacist better at deprescribing than
the Geriatrician for older patients with frailty in acute medicine?
Authors List Tamblyn, J., MClinPharm Candidate; Tan, AH., FRACP, MMedSci; Aravind, A., MRCP; Russell, G., FAIDH, MMgt (Dist); Chong, YH., PhD, FRACP MidCentral DHB, Palmerston North
Introduction: Polypharmacy is prevalent amongst older people and associated with multiple adverse outcomes1. Deprescribing is an emerging promising concept especially amongst older people with frailty2. There is a paucity of literature surrounding deprescribing in the acute setting during hospitalisation.
Aims: To examine if a clinical pharmacist alongside a geriatrician deprescribes more effectively when compared to a geriatrician-only team in older frail patients in the acute medical setting.
Methods: The clinical pharmacist participated in daily ward rounds on one acute geriatric service team, focusing on identifying polypharmacy, and deprescribing of potentially inappropriate medications (PIMS). The comparator group is a second team led by a geriatrician only. Both teams cohorted patients over 75-years old with frailty (Rockwood Clinical Frailty Score CFS >5) with acute medical presentations requiring hospitalisation. A prospective analysis is performed.
Results: There was a total of 254 patients in 3-months, mean age 85-years (p=0.85), average Rockwood-CFS 5.5 (p=0.67), and Charlston Comorbidity Score 6.4 (p=0.51). The pharmacist cohort resulted in more deprescribing (Odds Ratio OR 1.1, p=0.011) despite higher polypharmacy rate on admission (94% vs 86%, p=0.038). There were greater reductions in certain PIMS compared to the geriatrician-led cohort (opioids OR 4.1, p=0.036; proton pump inhibitors OR 2.6, p=0.07, nitrates OR 9.4, p=0.014), whilst rates of reduction of anticholinergic burden, psychotropics, statins, and antihypertensives were similar. There was a trend towards lower mortality rate in the clinical pharmacist cohort, with no difference in length of hospitalisation, readmission rates and inpatient falls.
Conclusions: A clinical pharmacist actively partaking in ward round increases safe deprescribing of PIMS amongst older patients with frailty in acute medicine compared to a geriatrician. This forms the basis of a true multidisciplinary team in the acute care of older person management.
References: (1) Masnoon N, et al. Predictors-of-unplanned-hospitalisation-in-the-older-population: The-role-of-polypharmacy-and-other-medication-and-chronic-disease-related-factors. AJA.2020;00:1-11. (2) Earl T, et al. Using-Deprescribing-Practices-and-the-Screening-Tool-of-Older-Persons' Potentially-Inappropriate-Prescriptions-Criteria-to-Reduce-Harm-and-Preventable-Adverse-Drug-Events in-Older-Adults. JPatSafe. 2020;16(3S):S23-S35.
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