TY - JOUR
T1 - Reducing inappropriate polypharmacy
T2 - The process of deprescribing
AU - Scott, Ian A.
AU - Hilmer, Sarah N.
AU - Reeve, Emily
AU - Potter, Kathleen
AU - Couteur, David Le
AU - Rigby, Deborah
AU - Gnjidic, Danijela
AU - Del Mar, Christopher B.
AU - Roughead, Elizabeth E.
AU - Page, Amy
AU - Jansen, Jesse
AU - Martin, Jennifer H.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84929118845&partnerID=8YFLogxK
U2 - 10.1001/jamainternmed.2015.0324
DO - 10.1001/jamainternmed.2015.0324
M3 - Review article
C2 - 25798731
AN - SCOPUS:84929118845
SN - 2168-6106
VL - 175
SP - 827
EP - 834
JO - JAMA Internal Medicine
JF - JAMA Internal Medicine
IS - 5
ER -