Targeted Medication Deprescribing in the Elderly: Results of a Pharmacist-Driven Procedure in a Transitional Care Unit

Abstract

OBJECTIVE: Assess the impact of a pharmacist-driven deprescribing procedure on reduction of target medications at discharge among geriatric patients receiving care in a hospital-based transitional care unit.<br/> DESIGN: Retrospective, single-center chart review.<br/> SETTING: Transitional care unit located within a hospital.<br/> PARTICIPANTS: Patients 65 years of age and older were included if they were admitted to the transitional care unit between June 1, 2017, and December 15, 2017, on one or more of the following target medication classes: antihistamines, benzodiazepines, hypnotic sleep aids, proton-pump inhibitors, and skeletal muscle relaxants.<br/> INTERVENTIONS: Pharmacists performed a structured review of patient's medications upon admission and utilized the deprescribing procedure developed by our institution to identify and deprescribe target medications in an attempt to optimize the patient's medication regimen prior to discharge.<br/> RESULTS: Overall, 129 patients on 198 target medications were included in the study. Patients were on an average of 1.5 ± 0.78 target medications at admission, which was reduced to 0.78 ± 0.73 at discharge (P < 0.001). Overall, a 50% reduction of target medications was achieved.<br/> CONCLUSION: A pharmacist-driven deprescribing procedure significantly reduced the quantity of target medications that older patients were discharged on.