Bundled Hyperpolypharmacy Deprescribing

Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. This randomized controlled trial tested the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. The study was set at Kaiser Permanente Northern California, an integrated health system with multiple pre-existing deprescribing workflows. Eligible patients were aged ≥76 years using ≥10 prescription medications. The intervention included physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. A priori primary effectiveness endpoints included change in the number of medications and in the prevalence of geriatric syndrome from 181-365 days after allocation. Second endpoints included utilization and adverse drug withdrawal effects. Information was obtained from the electronic health record.

Inclusion Criteria:Kaiser Permanente patientsAge ≥76 years≥10 drugs (excluding topicals) wheredrug filled ≥2 times in the past year anddrug last filled < 180 days agoExclusion Criteria:less than 12 months preceding enrollment at Kaiser Permanenteno primary care practitioner assignedon dialysishistory of heart, liver, lung, breast, or bone marrow transplantin hospiceunder active treatment for cancer during the past 12 monthshas received an intervention through the Pharmacy Targeted Deprescribing Program in the preceding year.