- Title
- Impact of a Comprehensive Intervention Bundle Including the Drug Burden Index on Deprescribing Anticholinergic and Sedative Drugs in Older Acute Inpatients: A Non-randomised Controlled Before-and-After Pilot Study
- Creator
- Fujita, Kenji; Hooper, Patrick; O'Donnell, Lisa Kouladjian; Sawan, Mouna; Baysari, Melissa; Hilmer, Sarah N.; Masnoon, Nashwa; Lo, Sarita; Gnjidic, Danijela; Etherton-Beer, Christopher; Reeve, Emily; Magin, Parker; Bell, J. Simon; Rockwood, Kenneth
- Relation
- Drugs and Aging Vol. 40, Issue 7, p. 633-642
- Publisher Link
- http://dx.doi.org/10.1007/s40266-023-01032-6
- Publisher
- Adis International
- Resource Type
- journal article
- Date
- 2023
- Description
- Introduction: Implementation of the Drug Burden Index (DBI) as a risk assessment tool in clinical practice may facilitate deprescribing. Objective: The purpose of this study is to evaluate how a comprehensive intervention bundle using the DBI impacts (i) the proportion of older inpatients with at least one DBI-contributing medication stopped or dose reduced on discharge, compared with admission; and (ii) the changes in deprescribing of different DBI-contributing medication classes during hospitalisation. Methods: This before-and-after study was conducted in an Australian metropolitan tertiary referral hospital. Patients aged ≥ 75 years admitted to the acute aged care service for ≥ 48 h from December 2020 to October 2021 and prescribed DBI-contributing medication were included. During the control period, usual care was provided. During the intervention, access to the intervention bundle was added, including a clinician interface displaying DBI score in the electronic medical record. In a subsequent 'stewardship' period, a stewardship pharmacist used the bundle to provide clinicians with patient-specific recommendations on deprescribing of DBI-contributing medications. Results: Overall, 457 hospitalisations were included. The proportion of patients with at least one DBI-contributing medication stopped/reduced on discharge increased from 29.9% (control period) to 37.5% [intervention; adjusted risk difference (aRD) 6.5%, 95% confidence intervals (CI) -3.2 to 17.5%] and 43.1% (stewardship; aRD 12.1%, 95% CI 1.0-24.0%). The proportion of opioid prescriptions stopped/reduced rose from 17.9% during control to 45.7% during stewardship (p = 0.04). Conclusion: Integrating a comprehensive intervention bundle and accompanying stewardship program is a promising strategy to facilitate deprescribing of sedative and anticholinergic medications in older inpatients.
- Subject
- Drug Burden Index (DBI); aged care; patients; intervention bundle
- Identifier
- http://hdl.handle.net/1959.13/1482272
- Identifier
- uon:50899
- Identifier
- ISSN:1170-229X
- Rights
- x
- Language
- eng
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