In-hospital deprescribing in the real world – a clinician-led approach to hyperpolypharmacy

Abstract

Background: A lack of clear guidelines for medication cessation has contributed to the proliferation of polypharmacy. Hospitalisation provides a unique opportunity for initiating deprescribing. Deprescribing interventions are usually pharmacist- or multidisciplinary team-led and are typically safe and beneficial for patients. However, few studies have explored interventions that are implementable by clinicians at the bedside. Aim: To explore the efficacy and feasibility of a clinician-led deprescribing intervention on an acute general medicine ward. Method: A multifaceted intervention was implemented comprising (a) education sessions on deprescribing and (b) a deprescribing alert in the bedside folders of patients with hyperpolypharmacy (>10 medications). Using a historical cohort study design, data from the intervention cohort were compared to a historical control group. A subset of the intervention cohort was surveyed after discharge regarding attitudes toward deprescribing. Results: We recruited 1333 patients and had complete data for 1169 (nintervention = 888, ncontrol = 281). The prevalence of hyperpolypharmacy decreased from 28% to 26% in the intervention cohort, but this reduction was not statistically significant (net change = −1, interquartile range [IQR] = −2–0; p = 0.26). There was similarly no statistically significant change in medication numbers due to the intervention across other subgroups. Most patients agreed they were taking too many medications and supported deprescribing. Conclusions: Despite observing no statistically significant effect of the intervention, we demonstrated the feasibility of introducing clinician-led deprescribing interventions in resource-poor, busy inpatient units. Simple, innovative deprescribing interventions in hospital settings, along with the measurement of long-term patient outcomes and medication adverse effects, should be investigated further in large inpatient cohorts.