Pharmacists Could Help Prevent Inappropriate Prescriptions For Older Adults: Study

To protect elderly patients from medical mistakes or inappropriate prescriptions, a new study suggests that pharmacies could play an important role in reducing use of potentially harmful drugs. 

In a study published this week in the the Journal of the American Medical Association (JAMA), researchers found that “deprescribing” programs help to reduce inappropriate prescriptions by nearly 50%.

Researchers from the Developing Pharmacist-Led Research to Educate and Sensitize Community Residents to the Inappropriate Prescriptions Burden in the Elderly (D-PRESCRIBE) study recruited community pharmacies in Quebec, Canada from February 2014 to September 2017 to participate in the program.

Nearly 500 patients were randomly selected to either be in an intervention group or control group. Patients were 65 years or older and taking one of four prescribed medications, including sedative-hypnotics, first-generation antihistamines, glyburide for diabetes, or nonsteroidal anti-inflammatory drugs (NSAIDs).

Patients were recruited from 69 community pharmacies. Pharmacists were encouraged to send patients in the intervention group an educational brochure about the benefits of deprescribing, or beginning a protocol to stop or reduce prescriptions that may be harmful or no longer needed.

They also sent the doctors of those patients information on evidence-based pharmaceutical opinion about deprescribing. The pharmacists in the control group provided the usual care to patients.

The findings indicate that 43% of patients in the intervention group were able to discontinue an inappropriate medication after six months. Comparatively, 12% of patients in the non-intervention group discontinued inappropriate medications.

Broken down by each category of medication, nearly half of the patients taking sedatives were able to discontinue medications they didn’t need or that were no longer appropriate. This is especially important among elderly patients. Sedatives can cause a person to experience drowsiness or dizziness, which may lead to a fall for an older adult.

One-third of patients taking glyburide for type 2 diabetes stopped taking inappropriate medications and nearly 60% of NSAID users were able to stop taking inappropriate NSAIDS by the six month mark.

Researchers noted the small sample size of antihistamine users prevented them from gathering complete data on those users.

Furthermore, none of the patients who stopped taking inappropriate medications experienced side effects requiring hospitalization.

Study authors warned, high rates of inappropriate prescribing persist among older adults. Nearly one-third of Medicare beneficiaries in the U.S. over the age of 65 have at least one inappropriate medication prescribed to them. In Canada, roughly 31% use inappropriately prescribed medications.

Taking inappropriate medications that are no longer necessary can lead to avoidable and harmful side effects and drug-related hospitalizations.

Many doctors refrain from taking patients off inappropriate medications for fear the patient may experience side effects or withdrawal. Some doctors indicate they simply don’t have time to safely step their patient down from the drugs.

Researchers of the new study warn it is important to establish pharmacy programs to discourage patients from taking inappropriate medications and discourage doctors from prescribing inappropriate prescriptions. By launching these types of programs, it can help lead older patients to take fewer unnecessary or harmful prescriptions.