Multidisciplinary Team Deprescribing Intervention for Polypharmacy in Elderly Orthopedic Inpatients: A Propensity Score-matched Analysis of a Retrospective Cohort Study

• Published in: Internal Medicine Vol. 61; no. 16; pp. 2417 - 2426
• Main Authors: Seto, Hiroyuki, Ishimaru, Naoto, Ohnishi, Jun, Kanzawa, Yohei, Nakajima, Takahiro, Shimokawa, Toshio, Imanaka, Yuichi, Kinami, Saori
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.08.2022; Japan Science and Technology Agency
• Subjects: Adverse events; aged; Cohort analysis; Delirium; deprescription; Emergency medical care; Internal medicine; Intervention; Multidisciplinary teams; Original; Orthopedics; Patients; Polypharmacy; potentially inappropriate medication; potentially inappropriate medication; aged; deprescription; orthopedics; polypharmacy
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.8929-21

Objective This study evaluated the effectiveness of a multidisciplinary team deprescribing intervention to reduce polypharmacy and potentially inappropriate medications (PIMs) in elderly orthopedic inpatients. Methods In this single-center retrospective observational study, orthopedic inpatients ≥75 years old and prescribed ≥6 different medications were enrolled as participants. Interventions comprised multidisciplinary team-led polypharmacy screening and suggestions regarding deprescribing any unnecessary medications during hospital stays. The primary outcome was reduction in the mean number of regular medicines and PIMs. Secondary outcomes included falls, delirium, and other adverse events during hospitalization as well as emergency department visits or unplanned hospital admissions within six months after discharge. Results After propensity score matching, 184 patients (intervention group, n=92; control group, n=92) were included in the analysis. The mean patient age was 83 years old. The mean number of prescribed medications and PIMs at admission were similar in both groups. The mean change in the number of regular medicines was -1.4 [standard deviation (SD), 2.3] in the intervention group and +0.2 (SD, 1.8) in the control group (p<0.001). The mean change in the number of PIMs was -0.5 (SD, 0.9) in the intervention group and +0.1 (SD, 0.8) in the control group (p<0.001). In-hospital adverse events other than falls and delirium were significantly less common in the deprescribing intervention group than in the control group. Conclusion Deprescribing intervention by our multidisciplinary team seems to have been effective in reducing the number of prescribed medicines and PIMs in elderly orthopedic inpatients, with some accompanying reduction in certain adverse events.