The following is a summary of “Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study,” published in the March 2024 issue of Nephrology by Bortolussi-Courval et al.
Patients undergoing dialysis commonly face the challenge of polypharmacy, often resulting in the prescription of potentially inappropriate medications (PIMs) and, subsequently, an elevated risk of medication-related harm, such as falls, fractures, and hospitalization. Deprescribing, a strategy aimed at discontinuing, reducing, or substituting medications with safer alternatives, emerges as a potential solution to mitigate these risks.
However, implementing deprescribing within routine medication reviews poses complexities and time constraints. This study sought to evaluate whether clinical decision support software, specifically MedSafer, could enhance the deprescribing process for dialysis patients. Through a prospective controlled quality improvement study design involving both intervention and control units, the efficacy of MedSafer in increasing deprescribing rates was assessed.
The analysis focused on comparing the proportion of patients with one or more PIMs deprescribed between the intervention and control units following a structured medication review. Results from the study involving 195 patients revealed a marked increase in deprescribing rates among those utilizing MedSafer, with a significant absolute risk difference (aRD) of 36.6% (95% CI=24.5-48.6; p<0.0001) and a number needed to treat (NNT) of 3. This underscores the potential of deprescribing clinical decision support, complemented by patient empowerment through informational brochures, as an effective and scalable intervention for addressing PIMs in the dialysis population. However, further validation through confirmatory randomized controlled trials is essential to solidify these findings and ascertain the broader applicability of such interventions in clinical practice.
Source: sciencedirect.com/science/article/pii/S2590059524000219
