Reducing inappropriate polypharmacy: The process of deprescribing

Ian A. Scott, Sarah N. Hilmer, Emily Reeve, Kathleen Potter, David Le Couteur, Deborah Rigby, Danijela Gnjidic, Christopher B. Del Mar, Elizabeth E. Roughead, Amy Page, Jesse Jansen, Jennifer H. Martin

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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.

Original languageEnglish
Pages (from-to)827-834
Number of pages8
JournalJAMA Internal Medicine
Volume175
Issue number5
DOIs
Publication statusPublished - 1 May 2015

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Polypharmacy
Pharmaceutical Preparations
Drug-Related Side Effects and Adverse Reactions
Inappropriate Prescribing
Observational Studies
Deprescriptions
Hospitalization
Health

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Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Couteur, D. L., Rigby, D., ... Martin, J. H. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827-834. https://doi.org/10.1001/jamainternmed.2015.0324
Scott, Ian A. ; Hilmer, Sarah N. ; Reeve, Emily ; Potter, Kathleen ; Couteur, David Le ; Rigby, Deborah ; Gnjidic, Danijela ; Del Mar, Christopher B. ; Roughead, Elizabeth E. ; Page, Amy ; Jansen, Jesse ; Martin, Jennifer H. / Reducing inappropriate polypharmacy : The process of deprescribing. In: JAMA Internal Medicine. 2015 ; Vol. 175, No. 5. pp. 827-834.
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Scott, IA, Hilmer, SN, Reeve, E, Potter, K, Couteur, DL, Rigby, D, Gnjidic, D, Del Mar, CB, Roughead, EE, Page, A, Jansen, J & Martin, JH 2015, 'Reducing inappropriate polypharmacy: The process of deprescribing' JAMA Internal Medicine, vol. 175, no. 5, pp. 827-834. https://doi.org/10.1001/jamainternmed.2015.0324

Reducing inappropriate polypharmacy : The process of deprescribing. / Scott, Ian A.; Hilmer, Sarah N.; Reeve, Emily; Potter, Kathleen; Couteur, David Le; Rigby, Deborah; Gnjidic, Danijela; Del Mar, Christopher B.; Roughead, Elizabeth E.; Page, Amy; Jansen, Jesse; Martin, Jennifer H.

In: JAMA Internal Medicine, Vol. 175, No. 5, 01.05.2015, p. 827-834.

Research output: Contribution to journalReview articleResearchpeer-review

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Scott IA, Hilmer SN, Reeve E, Potter K, Couteur DL, Rigby D et al. Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine. 2015 May 1;175(5):827-834. https://doi.org/10.1001/jamainternmed.2015.0324