Friday Apr 19, 2019
Four tools to help you identify patient medications that need to be deprescribed
More than a third of community dwelling adults age 62 to 85 take five or more medications,1 a situation called polypharmacy that can lead to adverse drug effects, medication nonadherence, increased mortality, higher cost, and functional impairment. Physicians can bring some order to this chaos through deprescribing, which involves identifying inappropriate or unnecessary medications and discontinuing them.
Here are four tools to help the process go easier:
• The Anticholinergic Burden Calculator(anticholinergicscales.es) can help you evaluate a patient’s potential for serious anticholinergic effects. This is a good place to start with geriatric patients, as reducing or eliminating anticholinergic burdens can often improve patients’ overall function and quality of life. Start with deprescribing those medications in the highest (level 3) category.
• The Beers List(www.priorityhealth.com) includes medications that pose the highest risk to older patients, along with alternatives. (For the most recent update, see the Journal of the American Geriatric Society(onlinelibrary.wiley.com).)
• Deprescribing.org(deprescribing.org) provides deprescribing guidelines and algorithms, patient decision aids, and an up-to-date resource list of evidence and research.
• MedStopper(medstopper.com) allows you to enter a drug list for a specific patient and receive recommendations regarding which medications might be discontinued or switched.
Once you have identified which medications to deprescribe, talk to your patient and develop a plan, which may involve discontinuing one medication at a time or tapering medications.
1. Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs. 2011. JAMA Intern Med. 2016;176(4):473-482.
Read the full FPM article: “Deprescribing Unnecessary Medications: A Four-Part Process."
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Posted at 09:00AM Apr 19, 2019 by FPM Editors