JAMA Internal Medicine· 2015Q1· Review
Reducing Inappropriate Polypharmacy
- 1,526citations
- Q1SCImago
- 2015year
Short summary
A proposed 5-step deprescribing protocol aims to reduce inappropriate polypharmacy, particularly in older adults, by systematically tapering or stopping medications with the lowest benefit-harm ratio.
AI-generated from the title and abstract; the full text is not read.
Key points
- The number of prescribed drugs is the primary predictor of inappropriate prescribing and adverse drug events in older patients.
- A 5-step protocol is proposed for deprescribing, involving drug ascertainment, risk assessment, benefit-harm evaluation, prioritization for discontinuation, and close monitoring.
- Deprescribing aims to minimize polypharmacy and improve patient outcomes by tapering or stopping medications.
- Despite existing barriers, strategies and resources are available to facilitate deliberate deprescribing.
AI-generated from the title and abstract; the full text is not read.
Abstract
Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed drugs. Deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies. A deprescribing protocol is proposed comprising 5 steps: (1) ascertain all drugs the patient is currently taking and the reasons for each one; (2) consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention; (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential; (4) prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes; and (5) implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Whereas patient and prescriber barriers to deprescribing exist, resources and strategies are available that facilitate deliberate yet judicious deprescribing and deserve wider application.
The authors' abstract, as published at the source. JAMA Internal Medicine, 2015 · DOI ↗
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Field: Geriatrics and Gerontology
Geriatrics and GerontologyMedicine