Educating Patients and Prescribers About Deprescribing to Reduce Medication Burden May Not Be Enough

Authors:
Kashelle Lockman, PharmD, MA
Sarah Greiner, PharmD

Reviewers:
Jennifer Pruskowski, PharmD, BCACP, BCGP
Stuart T Haines, PharmD, BCACP, BCPS

Citation:
Bayliss EA, Shetterly SM, Drace ML, et al. Deprescribing Education vs Usual Care for Patients with Cognitive Impairment and Primary Care Clinicians: The OPTIMIZE Pragmatic Cluster Randomized Trial. JAMA Internal Medicine. 2022;182:534-542. doi:10.1001/jamainternmed.2022.0502

The Problem

As age and illness advance, patients take increasingly more medications. Increasing numbers of medications in a regimen make it more challenging to take each as prescribed.  And worse! More medicines often result in more problems, including falls, cognitive impairment, and other adverse effects that can result in hospitalization and even death.¹ Older people living with cognitive impairment and dementia are at the greatest risk for these drug-related harms. In addition to compromising the quality and quantity of life, unnecessary polypharmacy also contributes to financial adverse effects for patients and families, as well as our health system and society. Estimates of the cost impact of unnecessary medication use in the US and Canada are in the billions.

It’s unsurprising that medication burden increases as we age. At each clinic visit, we consider starting new medications as part of our routine, but it’s still relatively uncommon to critically evaluate medications that could be deprescribed at each visit. How can we change the culture to embrace deprescribing as an integral part of patient care?  Perhaps provider- and patient-level interventions can change prescribing behaviors and increase deprescribing.