Patients who start a deprescribing intervention before their post-acute care admission have fewer medications at discharge and at a 90-day follow-up than their peers with usual care, researchers report.
The randomized clinical trial included 372 older adults aged 50 years and older who were taking five or more medications and who were scheduled to transition from a hospital to post-acute care. Nursing home residents and patients with six months or less to live were not included in the study.
The intervention cohort received an intervention protocol developed at Vanderbilt University Medical Center. Called Shed-MEDS, it is led by a pharmacist or nurse practitioner and included a comprehensive medication review and patient- or proxy-approved deprescribing recommendations. Subsequent deprescribing actions were initiated in the hospital and continued throughout the post-acute care stay.
14% fewer medications
Patients receiving the intervention had an average of 14% fewer medications at post-acute facility discharge and 15% fewer medications at a 90-day follow-up compared with the control group.
Receipt of the Shed-MEDS protocol also decreased the number of potentially inappropriate medications and lowered the burden of sedative and anticholinergic drugs, investigators reported. There was no evidence that the intervention was linked to adverse events or adverse drug events.
The control cohort received usual care at the hospital and throughout their post-acute stay.
“These findings demonstrated that a hospital-initiated, pharmacist- or nurse practitioner–led, patient-centered deprescribing intervention can effectively and safely reduce the medication burden among hospitalized older patients needing post-acute care,” the researchers concluded.
The study was published in JAMA Internal Medicine.
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