From buzzword to proven principle: Deprescribing leads latest issue of JPPR

From buzzword to proven principle: Deprescribing leads latest issue of JPPR

Deprescribing is again in the spotlight with a study into clinician-led deprescribing intervention on an acute general medicine ward leading the latest issue of the Society of Hospital Pharmacists of Australia (SHPA)’s flagship journal, while a leading global news magazine reports a growing number of ‘deprescribing networks’ run by interdisciplinary teams focused on patient safety.

Published in the Journal of Pharmacy Practice and Research (JPPR)’s April 2023 issue, ‘In-hospital deprescribing in the real world – a clinician-led approach to hyperpolypharmacy’ explores the efficacy and feasibility of a clinician-led deprescribing intervention, finding while indications exist to commence drug treatments, there are few to cease the use of long-term medications.

The study authors, Muhandiramge et. al. – from Monash and Deakin universities, the University of Melbourne, Austin Health and Eastern Health – note that: ‘Deprescribing is safe and potentially leads to a decrease in adverse drug reactions as well as unplanned hospitalisations.’

The researchers note that despite the challenges of clinician-led deprescribing in an acute medical ward – with the intervention described in the study not resulting in statistically significant deprescribing – ‘in-patient settings providing exceptional opportunities for deprescribing to be discussed and initiated’.

The research comes weeks after SHPA member Dr Emily Reeve was featured in ‘Too many people take too many pills’, a global study in The Economist in which she discusses her observations and concerns around patients overwhelmed by the number of medicines they were prescribed each day. Dr Reeve now runs one of the increasing number of ‘deprescribing networks’ set up by pharmacists, doctors and nurses.

SHPA President Tom Simpson says hospital pharmacists are behind the rise of ‘deprescribing’ from a new phrase two decades ago to a proven principle embraced by team-based care.

‘In 2003, SHPA’s JPPR saw the world’s first journal published use of the term “deprescribing”. ‘Today we continue to see an increase in calls to combat proliferating polypharmacy and hyperpolypharmacy, defined by the World Health Organization as the concurrent use of five or more, and ten or more medicines, respectively. These are associated with functional decline, higher healthcare costs, hospitalisation and increased mortality.

‘We support the authors’ call that more needs to be done to raise awareness of the importance of deprescribing, with the researchers finding patients typically wish to reduce the number of medicines they take, something our members and their clinician peers see every day.’

Mr Simpson says SHPA is uniquely positioned to lead the push for more formal recognition of deprescribing as a core tenet of medicines safety.

‘As the home of team-based pharmacy care that wraps around each patient, SHPA will continue to advocate for deprescribing as a pillar of medicines safety programs, as it places the individual in the centre and empowers them in decisions about their medicines.

‘SHPA’s leadership in this space includes our landmark Reducing Opioid-related Harm report (2018), highlighting how hospital-initiated opioids can have devastating long-term consequences, and our evidencebased recommendations for optimal medicines management within aged care services, including a focus upon medication histories, medication reconciliations and compassionate conversations to reduce medication-related risks.

‘There is huge potential in concerted efforts to reduce hyperpolypharmacy and “deprescribing” provides a conceptual and practical framework. ‘As with so many innovations in Australian pharmacy, this focus begun in our hospitals, but deprescribing must be a core value of all healthcare teams to realise maximum benefit to patient safety across Australia.’