Background and importance The WIDE (Wholistic Integrated Deprescribing Evaluation) review is an innovative model of patient-led, pharmacist facilitated medication review. It involves establishing patients‘ priorities and experiences of their medicines, collaborating with primary care providers and evaluating if medicines should be deprescribed because their potential harms outweigh their potential benefits. Frailty is synonymous with vulnerability, including to medication harms. To assess the potential for harm, the WIDE review model incorporates the STOPP/START criteria and the medication appropriateness index (MAI) tools, the use of which have demonstrated improvements in patient outcomes. However, the impact of a patient-led deprescribing model has not yet been studied in this setting.
Aim and objectives To examine the impact and cost effectiveness of WIDE reviews.
Material and methods This quantitative prospective cohort study was conducted over 8 weeks.
Inclusion criteria inpatients aged >65 years and prescribed >5 regular medications who screened positive for frailty (PRISMA 7 score >3). Critically ill patients were excluded. Eligible patients were randomly allocated to the intervention or control group.
Regular medications were enumerated and screened using the STOPP/START criteria on admission and discharge. The intervention group received a WIDE review and their MAI score was calculated on admission and discharge. In conjunction with the patients and their consultants, deprescribing plans were devised and communicated to their GPs and community pharmacists.
Results A total of 20 intervention and 20 control group patients were enrolled. Patient characteristics (age, sex and length of stay) were similar for both groups. A total of 65% of STOPP and 62% of START criteria were addressed in the intervention group versus 12% and 5%, respectively, in the control group. In the intervention group, 83 medications were stopped, 23 doses were reduced and the total MAI score was reduced by 64%. Cost savings to the annual drug budget alone represented a 9:1 return on investment of hospital pharmacist time. Most discontinuations and dose reductions were sustained (98%) and 92% of future recommendations were enacted on 6 months of follow-up.
Conclusion and relevance Pharmacists performing patient-led WIDE reviews significantly improved medication appropriateness and realised compelling cost savings. A large scale, multi-site study is warranted to demonstrate the reproducibility of these results.
References and/or acknowledgements No conflict of interest.
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