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INT-010 Drugs and clinical situations that offer the opportunity of deprescribing in patients with multiple chronic conditions: Lesschron criteria

Abstract

Background It is necessary a specific tool for deprescribing drugs in patients with multiple or complex chronic conditions.

Purpose To design an easy for use tool for identifying opportunities of deprescribing related with the pronostic in patients with multiple chronic conditions.

Material and methods

  • Literature review and electronic brainstorming to identify drugs-clinical situation that offer the opportunity of deprescribing (scenarios).

  • Delphi methodology to select the most appropriate scenarios to be included in the tool.

  • Meeting of the research group to discuss the content and design of the tool, according to definition of deprescribing.

Results

  • There were obtained 100 scenarios; 50 duplicates according to life expectancy (1 year or more)

  • Eleven experts participated in the Delphi methodology. They assessed 79 scenarios as appropriate, 19 as uncertain and 2 as inappropiate.

ResultsThere were excluded from the tool the following scenarios: Refered to “acute indications”: diuretics for hydropic decompensation and acute pulmonary oedema; inhaled corticosteroids for COPD exacerbations Considered as “no indicated”: peripheral vasodilators for venous insufficiency, metoclopramide for nausea and vomiting when there is tolerance to their origin, metformin with low BMI, iron/erythropoietin in anaemia of unknown origin, proton-pump inhibitor in prophylaxis of bleeding without gastrolesive medication and inhaled corticosteroids for COPD phenotype not exacerbator Finally, 27 scenarios were selected for the tool. Each of them consist of: drug-indication for which it is prescribed, deprescribing condition,health variable to monitor and time of follow up. They were organised in a table according to ATC system, beeing represented: Alimentary tract and metabolism (4 scenarios): oral antiabetics, acarbose, metformin and vitamin D/ calcium supplements –Blood and blood forming organs (4): oral anticoagulants (2), ASA and ASA and clopidogrel combination – Cardiovascular System (4): antihypertensives, nimodipine and statins in primary and secondary prevention – Genito-urinary System (4): anticholinergics (2), alpha adrenergic blockers and allopurinol – Musculo-skeletal System (2):Bisphosphonates in primary and secondary prevention – Nervous system (8): haloperidol/risperidone/quetiapine,benzodiazepines, Z drugs, other antidepressants (2), anticholinesterases (2) and citicoline – Respiratory System (1):Mucolytics and expectorants.

Conclusion LESS-CHRON criteria allow us to identify medicines, appropriately prescribed, that under certain conditions of clinical stability and/or poor patient prognosis make them liable to withdrawal. It is neccesary its validation.

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