D-PRESCRIBE: Pharmacist-Led Intervention Can Reduce Inappropriate Medications in Older Adults

MedicalResearch.com Interview with:
Cara Tannenbaum, MD, MSc Director | Directrice Canadian Deprescribing NetworkCara Tannenbaum, MD, MSc

Director | Directrice
Canadian Deprescribing Network

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: The D-Prescribe trial was driven by the need to show that seniors can cut down on their medication in a safe and effective manner. Pharmacists intervened in a proactive way to flag patients who were on potentially risky meds such as sleeping pills, NSAIDs and glyburide and to inform them of the risks, using an educational brochure. Pharmacists also communicated with their physician using an evidence-based pharmaceutical opinion to spark conversations about deprescribing. As a result, 43% of patients succeeded in discontinuing at least one medication over the next 6 months.
 

MedicalResearch.com: What should readers take away from your report?

Response: Readers should integrate these evidence-based tools for deprescribing into their everyday practice – by spreading the word to friends and colleagues, or even by sharing with family members. After all, who doesn’t want to reduce the number of pills they are taking if it’s not necessary anymore?

All materials are available free of charge at www.deprescribingnetwork.ca , including alternate ways to get a good night’s sleep without medication.
  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: I’d love to see the D-Prescribe process embedded in pharmacy software, patient portals and electronic medication systems to prompt awareness and action around deprescribing risky meds for seniors. There’s nothing worse than having to treat an older woman who’s fallen going to the bathroom at night because the sleeping pill that she took affected her balance. Her fall – and often hip fracture – might have been prevented if she had been informed of the risks of sleeping pills and tried more natural methods of getting a good night’s sleep. We need to make sure that this information gets into patients’ hands in a timely fashion.
 

MedicalResearch.com: Is there anything else you would like to add?

Response: Some pharmacists have expressed reluctance to aid in deprescribing because their salary and revenue depends on filling prescriptions. There is something fundamentally wrong with a system that rewards acts alone, and not quality outcomes. I hope our study triggers high level conversations among public health payers and private insurers on how to revamp the current payment methods to pharmacists in order to reward truly great care for seniors. Let’s fix things now. We’ve waited long enough.

Citation:

Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older AdultsThe D-PRESCRIBE Randomized Clinical TrialJAMA. 2018;320(18):1889–1898. doi:10.1001/jama.2018.16131

Nov 14, 2018 @ 4:02 pm 

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