Pharmacy-led interventions successful in deprescribing of high-risk medication, review suggests

Looking at 24 studies involving more than 4,000 adults, researchers found that all types of pharmacy-led interventions resulted in a greater discontinuation of medicines, compared with usual care.
Pharmacist with prescription

Community pharmacist-led interventions can lead to successful deprescribing of high-risk medication, as well as improving quality of life in patients with severe mental illness, a review published in the British Journal of Clinical Pharmacology has suggested.

Researchers carried out a review of 24 studies, investigating community pharmacy-led deprescribing interventions in a total of 4,231 adults.

The studies were grouped into four categories according to the method of the intervention: educational interventions; interventions involving medication review, consultation or therapy management; pre-defined pharmacist-led interventions; and pharmacist-led collaborative interventions.

Taken from library and clinical trials databases searched from inception to March 2020, the studies showed that all forms of intervention resulted in a greater discontinuation of medicines, compared with usual care, which differed depending on the measure being studied.

The authors found that interventions involving a medication review could lead to successful deprescribing of high-risk medication, such as benzodiazepines and anticonvulsants, although they did not appear to affect the risk or rate of falls, hospitalisation, mortality or quality of life.

One such study of 186 patients found that those invited to a medication review at a community pharmacy were more likely to have discontinued use of a high-risk medication, such as benzodiazepines and anticonvulsants, or to have had the dosage reduced.

However, another study — which looked at 29 patients with schizophrenia, schizoaffective disorder and bipolar disorders — found that deprescribing through the use of a medication review improved quality of life, as well as improving anticholinergic side effects and memory.

The eight studies that looked at predefined pharmacist-led deprescribing and educational interventions also reported financial benefits. These included “step-by-step protocols implemented and managed by pharmacists”, the study said.

Publishing the results on 21 June 2021, the researchers said that theirs was the first systematic review to assess information on deprescribing interventions initiated and/or led by community pharmacists and their efficacy and impact on clinical outcomes.

They concluded that community pharmacists could successfully lead deprescribing interventions and were a “valuable partner” in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.

Commenting on the review, Cherise Gyimah, principal pharmacist in community health services at University Hospital Lewisham and co-founder of the English Deprescribing network, said: “Deprescribing goes well beyond that initial shared decision to withdraw or stop medicines.

“We welcome the results of this systematic review which highlights the important role community-based pharmacists, who are well placed, play in providing the necessary monitoring and post follow up with the view to ensure the success of the intervention.”

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Citation
The Pharmaceutical Journal, PJ, June 2021, Vol 306, No 7950;306(7950)::DOI:10.1211/PJ.2021.1.93193