Deprescribing in frail older people – Do doctors and pharmacists agree?

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Abstract

Background:

Deprescribing may reduce harmful polypharmacy in older people and is an accepted clinical practice; however, data to guide deprescribing decisions are scarce.

Objectives:

This study aimed to determine if physicians and pharmacists agree on medicines to deprescribe.

Methods:

Two physicians and two pharmacists independently applied a deprescribing decision-making aid to clinical and medicines data collected during a deprescribing trial of frail older people in four residential aged care facilities. The consensus list of medicines selected for deprescribing by the physicians was compared with the consensus list selected by the pharmacists. Lin's concordance correlation coefficient (CCC) was used to assess agreement in the number of medicines, and agreement on each specific medicine was assessed using the level 2 intra-cluster correlation (ICC) for medicine within patient.

Results:

Physicians and pharmacists had substantial agreement on the number of medicines to deprescribe (CCC = 0.70; 95% CI: 0.58, 0.82), with a difference of 1.8 ± 2.0 total targeted medicines. For specific medicines, the agreement was moderate (ICC = 0.45, 95% CI: 0.32, 0.58). When considering only orally administered medicines, physicians and pharmacists had substantial agreement (CCC = 0.73; 95% CI: 0.61, 0.84) in the number of medicines, but only moderate agreement for the specific medicines (ICC = 0.44, 95% CI: 0.30, 0.59).

Conclusions:

Physicians and pharmacists had substantial agreement in the number of medicines they targeted to deprescribe and to continue, but physicians targeted a greater number of medicines for deprescribing than pharmacists. However, they had only moderate agreement in the specific medicines to deprescribe. This suggests that the deprescribing decision-making aid is a useful tool for health professionals to use when considering medicines to deprescribe.

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