Background and importance Polypharmacy and the use of potentially inappropriate medication are frequent in nursing homes and are associated with adverse health outcomes. Deprescribing has been proposed as a way to curtail this problem; however, the best way to implement deprescribing and its real impact are still unclear.
Aim and objectives To compare two different deprescribing strategies and to assess the impact of their application in a nursing home.
Material and methods Quasi-experimental study of pre-post design in a nursing home July–September 2020. Inclusion criteria: inpatients aged >65 years and >5 medications. The pharmacist applied the LESS-CHRON criteria (LCs) and the good Palliative-Geriatric algorithm (gPG) to the same population to asses the differences. If the individual met the criteria for deprescription an intervention was made. Gender, age, number of drugs, intervention, organ system involved and interventions accepted were registered. The reduction of LCs was evaluated. The main variable was the impact on the average number of medications per patient according to the strategy used if all the interventions were accepted.
Results The treatment of 33 residents was reviewed. Median age was 74 years and 40.7% were men. The average number of medications per patient was 9.4.
LCs: 28 criteria were detected in 17 different residents. 32.1% involved cardiovascular system (55.5% regarding antihypertensives) and 28.5% nervous system. 8/28 proposed interventions were accepted, reducing the number of LCs by 28.5%.
gPG algortihm: 21 recommendation were added resulting in a total of 49 in 25 patients. Of these 21, 80.9% were aimed at suspending drugs not included in the LCs and 14.2% at reducing doses. 66.6% of the proposed interventions were accepted. Encompassing the two strategies, 44.8% of the interventions carried out were accepted.
Acceptance of all interventions would have meant a reduction of 1.27 medications per resident on average applying the gPG versus a reduction of 1.03 according to the LCs.
Conclusion and relevance The LCs are a tool to help deprescription in individuals with multimorbidity, especially those related to the cardiovascular system; however, it is necessary to validate whether they are useful in patients with a longer life expectancy, where an algorithm such as gPG may be preferable.
References and/or acknowledgements LESS CHRON: tool for deprescribing in patients with multimorbidity.
Conflict of interest No conflict of interest
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