Polypharmacy Clinical Trial
Official title:
Deprescribing of Symptomatic Medications in Patients Receiving Rehabilitative or Subacute Care
Deprescribing is a systematic method of withdrawing potentially inappropriate or unnecessary
medications and is warranted in the elderly due to the high prevalence of polypharmacy. In
particular, symptomatic control medications, such as acid suppressants, laxatives and
painkillers, are frequently prescribed and continued, though such medications are rarely
needed on a long-term basis.
Therefore, the study objectives were to determine the cost savings, effects and feasibility
of implementing a systematic process of deprescribing medications for symptomatic management,
namely, acid suppressants, laxatives, analgesics, and antiemetics.
Deprescribing is a systematic process of identifying and withdrawing drugs, which are
potentially or currently causing more harm than benefit to patients, based on each individual
patient's condition, treatment goals and level of functioning. Deprescribing needs to be
patient-centric with shared decision-making between patients or caregivers and the
multidisciplinary care team. Five distinct steps of deprescribing have been elucidated, and
they comprise: 1) performing a comprehensive patient medical/medication history; 2)
considering the overall risk and appropriateness of drugs; 3) assessing possibility of and
planning drug discontinuation; 4) initiating and documenting drug discontinuation; and 5)
monitoring effects and providing patient support.
Deprescribing is necessary in elderly aged 65 years and above due to the higher prevalence of
polypharmacy and unnecessary and inappropriate medication use, compared to younger age
groups. In Singapore, statistics from an acute restructured hospital in 2013 showed that 50
percent or more of inpatients were discharged with at least five chronic medications.
The discontinuation of medications has been trialled in earlier studies without causing
significant adverse effects or symptom recurrence. Positive outcomes demonstrated include
enhanced cognition, improved health and reduced falls. However, it is necessary to
investigate the effects and feasibility of deprescribing in the present local setting, where
healthcare perceptions, and associations between medication discontinuation and patient
clinical outcomes may be different from other studied populations.
Therefore, this randomized controlled intervention study was conducted in a community
hospital in Singapore to determine the cost savings, effects and feasibility of implementing
a systematic process of deprescribing medications for symptomatic management, namely, acid
suppressants, laxatives, analgesics, and antiemetics.
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