– Phd candidate, Department of Clinical Pharmacology & Pharmacy, Amsterdam UMC, location VUmc, Amsterdam, Netherlands, Netherlands
Background: Background Overtreatment with cardiometabolic medication is a common phenomenon in older patients and up to 20% of these patients may be eligible for deprescribing. Deprescribing may decrease the risk of adverse drug events and is indicated when a drug may lead to more harm than benefits.
Objectives: The LeMON study aims to develop, implement and evaluate a standardized template medication reviews using evidence based tools and training to support deprescribing.
Methods: A clustered randomized controlled study involving twenty community pharmacists (CPs). Pharmacists were asked to conduct a clinical medication review (CMR) in 10 patients. The intervention group received a training on background and the use of tools supporting deprescribing cardiometabolic medication and the control group performed CMR according to standard practice. Follow-up took place within four weeks (T1) and after three months (T2) following the CMR. Patients 70 years or older; polypharmacy and chronic use of at least one blood pressure medicine and having a systolic blood pressure below 140 mmHg, or chronic use of glucose lowering medication and HbA1c level below 54 mmol/mol were included. A generalized estimating equations (GEE) model will analyze the differences between the intervention group and control group. Age and sex can be related on the amount of medication, and therefore to the reduction of medication. These variables will be analyzed as potential confounders . Adjustment will be made for number of medication at baseline level by including it as a fixed effect.
Results: In total 127 (85%) patients were included, whereof 58 in the intervention group and 69 in the control group. 83% of the patients in the intervention group and 71% of the control group ceased 1 or more medication. In the follow up moment after 12 weeks in the intervention group 53% of the patients still had their medication ceased. We found 1.53 more odds (corrected for age, number of medication, sexe) to cease cardiometabolic medication after CMR with focus on deprescribing cardiometabolic medication than with usual care.
Conclusions: This study shows that the introduction of a CMR training with focus on deprescribing cardiometabolic medication leads to more deprescribing of (cardiometabolic) medication, although not significant. Further development of selection of specific patients with cardiometabolic diseases could make the process of CMR with focus on deprescribing more efficient.
