Resumen de Deprescribing program in pluripathological elderly patients at a general hospital
Sara Giménez Giner, Antonio Llopis, A.C. Cercós Lletí, Oreto Ruiz Millo, Pilar Campillos Alonso, Juan Pablo Ordovás Baines, Mónica Climente Martí
Objective: To analyze a deprescribing program (PDES) implemented in pluripatho- logical and polymedicated elderly patients during hospital stay and evaluate the acceptance by Primary Care to the deprescription conducted.
Method: Prospective longitudinal observational study, lasting five months (September 2018 - January 2019), conducted in the Short Stay Unit (SSU) of a general hospital. Elderly (≥65 years), pluripathological (≥2 chronic diseases) poly- medicated patients (≥5 medications) were included. In the PDES, the medical- pharmaceutical team carried out an optimization of the pharmacotherapy adapting it to the current clinical situation of the patient and his life expectancy in order to deprescribe inadequate prescriptions. If they were not deprescribed during the hospital stay, the process was completed with a deprescribing proposal addressed to Primary Care (PC) through the hospital discharge report for the continuity of care of the PDES.
The deprescribing tools used were Good Palliative-Geriatric Practice Algo- rithm and Medstopper. The following variables were analyzed: related to the pa- tient (age, sex, comorbidities, chronicity level and hospital stay), treatment (prior to admission and at discharge: number of drugs and inappropriate medications), started deprescription (type and implicated drugs) and continuity in PC (potential drugs for later deprescribing and acceptance after first medical visit, one month and six months). Deprescribing actions were classified as suspensions, dose ad- justments, additions or changes for therapeutic alternatives.
Results: From 844 patients admitted to the SSU during the study period, 58 patients (6.9%) were included in the PDES, with mean age 86.4 (±5.7) years, 5.8 (±2.2) comorbidities and treatment with 10.4 (±3.4) medications. In these 58 pa- tients, PDES identified 208 inappropriate medications; among these, 113 (54.3%) were deprescribed, with a global average of 1.95 deprescriptions per patient, being the most frequent: cardiovascular system (52.2%), alimentary tract and metabolism (14.2%), nervous system (11.5%), blood and hematopoietic organs (11.5%). The deprescribing actions performed were 51 (45.9%) suspensions, 32 (28.8%) changes, 17 (15.3%) additions and 11 (9.9%) dose adjustments. Depre- scribing acceptance by the PC physician reached 86% of the patients after the first medical consult, reducing to 77.4% after one month and 58.5% after six months. Deprescribing reversions were involved in 66.7% to the cardiovascu- lar system. The 95 (45.7%) non-deprescribed medications during hospitalization were classified as: nervous system (54.7%), cardiovascular (22.1%), alimentary tract and metabolism (16.8%). These drugs candidates for potential deprescrip- tion were identified at the hospital discharge report as a deprescribing proposal directed to PC.
Conclusions: The prevalence of polymedication in frail elderly patients is high, reaching 35% the inappropriate medication that is potentially deprescriba- ble. During the hospital stay it is confirmed that approximately half of these can be deprescribed, mainly drugs related to cardiovascular pathologies. However, it is essential to ensure the continuity of care in PC so that the deprescription initiated during hospitalization is maintained, specifically for that pharmacotherapy with greater tendency to be reintroduced as the involved with the cardiovascular system; and it also gets completed upon discharge for those medications that require progressive deprescription, especially drugs related to the nervous system, in order to optimize the chronic treatment of patients.
