Background Patients with multimorbidity are an especially complex population. Multimorbidity is associated with poorer health outcomes and significant polypharmacy. These make patients more vulnerable to drug-related problems, causing a higher number of hospital admissions. This kind of population is common in nursing homes, and the withdrawal of medications might be an appropriate decision, resulting in significant clinical benefits. A review and evaluation process of long-term therapeutic plans aiming to stop, substitute or reduce the dosage of those drugs that under certain clinical conditions can be considered unnecessary or inappropriate, is necessary.
The List Evidence-baSed depreScribing for CHRONic patients criteria (LESS-CHRON) is a list of 27 drugs and specific clinical situations thatpresent an opportunity for deprescribing in patients with multimorbidity or similar situation (chronic, elderly with comorbidities, polymedicated).
Purpose The aim of this study was to review all the medical treatments and clinical situation of the institutionalised patients in nursing homes, using LESS-CHRON and analyse the pharmacist interventions.
Material and methods Cross-sectional study in June 2018. We included all the nursing home residents older than 65 years in a residential care centre linked to a hospital pharmacy. We reviewed, with the physician responsible, the pharmacological treatment and clinical situation of the residents to assess the benefits and risks of medication withdrawal, then we valued the acceptance.
Results We included 55 nursing home residents, 50% males, mean age 82.5±9 years. The mean drugs prescribed per patient was 8.5±4.4. Seventy-three per cent of the residents had a Charlson comorbidity index ≥5. We detected 39 inappropiate prescriptions by LESS-CHRON: 18% (seven) digestive system drugs, 41% (16) blood and cardiovascular system drugs, 5% (two) genitourinary tract and 36% (14) central nervous sytem. After the clinical review and evaluation process with the physician, the acceptance intervention rate to reduce dose or stop medication was 10 (26%). However, of the 29 (74%) inappropiate prescriptions without modifications in the treatment, 22 had a clinical explanation.
Conclusion LESS-CHRON is a suitable tool for clinical practice to select which patients can benefit from deprescribing and can avoid several adverse events related to drugs, but requires a good knowledge of the clinical history and work in common with physicians.
References and/or acknowledgements No conflict of interest.