Authors (including presenting author) :
Mak WC (1), Shiu YSJ (1), Cheung SYR (1), Chan TY (2), Yeung J (2), Wong B (1)
Affiliation :
(1) Pharmacy, Kwong Wah Hospital, (2) Medicine and Geriatrics, Kwong Wah Hospital
Introduction :
Polypharmacy is a common health problem in geriatric patients. Deprescribing potentially unnecessary drugs is a simple and effective strategy to reduce risk of adverse drug events. A physician-pharmacist partnership on deprescribing in geriatric outpatient clinic was advocated by our pharmacists and PPIs were targeted at the pilot stage.
Objectives :
1. To reduce polypharmacy in geriatric patients; 2. To facilitate deprescribing by conducting pharmacist interviews with patients and extracting relevant clinical information prior to doctors’ appointment; 3. To proactively identify and rectify potential drug-related problems
Methodology :
A PPI deprescribing algorithm was adapted from international clinical practice guidelines. Geriatric outpatients who were receiving PPI and at least 3 other chronic drugs were included. Patients on antiplatelets, anticoagulants, corticosteroids or NSAIDs were excluded. Pharmacists would screen patients’ medical profiles and identify those who were potentially suitable for deprescrbing PPI according to pre-specified algorithm. Pharmacist interviews with targeted patients were conducted before scheduled outpatient follow-up. If both the patient and pharmacist agreed for deprescribing, standardized deprescribing recommendations would be attached to patient’s medical records for physicians to review. In order to assess patient outcomes after deprescribing PPI, the Reflux Symptom Questionnaire 7-day Recall (RESQ-7) was conducted during pharmacist interviews and 4 weeks after deprescribing PPI via telephone.
Result & Outcome :
From November 2021 to December 2022, a total of 371 episodes from 199 patients were screened and 93 pharmacist interview attendances were recorded. PPI deprescribing recommendations were made in 77 episodes from 63 patients and the physicians acceptance rate was 93.5%. The top 2 reasons for deprescribing were “No ongoing indication” (68.1%) and “Upper Gl symptoms without endoscopy; asymptomatic for 3 consecutive days” (16.7%). Besides, 33 non-PPI/non-deprescribing related interventions were documented and the physicians’ acceptance rate was 74.2%. Baseline and 4-week post-PPI deprescribing scores of RESQ-7 were completed in 57 out of 63 patients. Paired t-tests were performed to compare symptoms (heartburn; regurgitation; burping; and hoarseness, cough, difficulty swallowing) at 4 weeks with baseline and there was no statistical difference in all domains. In conclusion, our study showed that deprescribing in elderly can be accomplished by a physician, pharmacist and patient partnership model with favorable patient outcome.
