Clinical decision portal may help tackle inappropriate medication for patients on dialysis
Key takeaways:
- Overall, 39.7% of patients in an intervention unit had potentially inappropriate medications deprescribed.
- In the control unit, 3.1% of patients did.
Deprescribing through clinical decision support along with providing safety brochures may be an effective method to address potentially inappropriate medications for patients on dialysis.
Deprescribing involves discontinuing, reducing or switching certain drugs to alternative options to improve the welfare of adults in this population, researchers wrote in a study.
“The burden of taking multiple medications in patients who receive dialysis is substantial,” Émilie Bortolussi-Courval, RN, of McGill University Health Centre in Montreal, Canada, wrote with colleagues. “Potentially inappropriate medications (PIMs) may have limited benefit, can increase a patient’s pill burden and are associated with an increased risk of adverse drug events.” Low deprescribing may be “related to the complexity of medical admissions for dialysis and, perhaps, due to a lack of dialysis-specific deprescribing rules.”
The prospective, controlled, quality improvement study with a contemporaneous control followed 195 patients on hemodialysis in two outpatient dialysis units in the city. Included patients were prescribed at least five medications. Investigators used the web-based clinical decision portal MedSafer to find candidate PIMs for deprescribing.
Patients were categorized into either an intervention or control unit, with 127 and 68 patients, respectively. During planned biannual medication review, patients in the intervention unit received EMPOWER brochures with safety information on prescribed PIMs. In the control unit, patients received usual care alone. The proportion of patients with at least one PIM deprescribed was compared between each group.
Findings showed a higher portion of patients in the intervention unit had at least one PIM deprescribed vs. patients in the control unit. Overall, 39.7% of patients in intervention had PIMs deprescribed, while 3.1% of patients in the control unit had the same outcome.
This difference translated to an absolute risk difference of 36.6% and a number needed to treat of three, according to researchers, indicating the effectiveness of using MedSafer.
“Deprescribing through clinical decision support in hemodialysis can be effective when paired with the usual medication reconciliation workflow,” they wrote. “Future studies will need to evaluate the generalizability and scalability to multiple centers and other countries. Ideally, these studies will have a large enough sample size to study the impact on [adverse drug events] and longer follow-up to evaluate the durability of the intervention.”
Editor’s note: On March 28, 2024, the disclosures were updated to correct the co-owners of MedSafer.
Collapse
Read more about