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When too many meds are the problem: The benefits of deprescribing

April 13, 2017

    We don't often think of pharmacists taking medication away from patients, but that's exactly what deprescribing protocols are designed to do.

    Deprescribing is defined as the planned process of reducing or stopping medications that may no longer be of benefit or may be causing harm. These practices are especially relevant for aging patients with chronic diseases who are often prescribed duplicative or unnecessary medications that can end up doing more harm than good. In fact, 44% of frail, elderly patients were given at least one unnecessary drug at discharge, according to a study of Veteran's Affairs hospitals.

    Instituting pharmacist-led deprescribing protocols as part of medication reconciliation can lead to major benefits for both patients and health systems.

    1. Pharmacist-led deprescribing protocols may help reduce readmissions

    UCLA identified a need for a dedicated pharmacy position to manage the medication regimens of their geriatric patients, who often take more medications and have different pharmacokinetic reactions to drugs than younger age groups. After hiring a clinical pharmacist specializing in geriatric care, UCLA reduced readmissions related to drug problems by 86% in the unit served.

    One key to the pharmacist's success is the support he has from the organization and other clinicians. In addition to directly counseling patients, the pharmacist frequently collaborates with prescribing physicians, providing education on appropriate prescribing patterns for the elderly and offering medication consultation services.

    2. Deprescribing may provide relief for patients and improve quality of care

    Given that more medications can mean more out-of-pocket costs, more things to remember, and more complexity, patients are usually relieved to have their medication regimen simplified.  

    Before making any medication changes, UCLA's clinical pharmacist works with patients' families to create an accurate, comprehensive medication list. After alterations to the list are made, the pharmacist thoroughly explains the new regimen and its benefits to individual patients. This pharmacist will also make follow-up calls to patients to ensure that they continue to take their post-discharge medications correctly.

    3. Deprescribing can significantly reduce overall health care spending

    Overprescribing is not only costly for patients, but also contributes to massive medication-related health care spending. One study showed that adverse drug events contribute more than $3.5 billion annually to national health care costs. If health systems are serious about improving quality of care and reducing costs, especially among the aging population, they would be wise to consider utilizing a clinical pharmacist's expertise for medication reconciliation and instituting deprescribing protocols.

    Keep an eye out for more Pharmacy Executive Forum research on how the pharmacy can help reduce costs, improve patient care, and lower readmissions rates.

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