Martin P, et al. - Among community-dwelling older adults, researchers compared the efficacy of a consumer-targeted, pharmacist-led educational intervention vs usual care on discontinuation of inappropriate medication. Among older adults in Quebec, greater discontinuation of prescriptions for inappropriate medication after 6 months was reported due to a pharmacist-led educational intervention vs usual care.

Methods

• Experts conducted a cluster randomized trial that recruited community pharmacies in Quebec, Canada (February 2014 to September 2017; follow-up until February 2018), and randomly allocated them to intervention or control groups.
• The patients that were included in this study were adults aged ≥ 65 years who were prescribed 1 of 4 Beers Criteria medications and were recruited from 69 community pharmacies.
• They encouraged the pharmacists in the intervention group to send patients an educational deprescribing brochure in parallel to sending their physicians an evidence-based pharmaceutical opinion to recommend deprescribing.
• Usual care was provided by the pharmacists in the control group.
• They noted the occurrence of randomization at the pharmacy level, with 34 pharmacies randomized to the intervention group (248 patients) and 35 to the control group (241 patients).
• They blinded the patients, physicians, pharmacists, and evaluators to outcome assessment.
• Discontinuation of prescriptions for inappropriate medication at 6 months, ascertained by pharmacy medication renewal profiles, were included in the main outcomes and measures.

Results

• A total of 437 of 489 (89%) patients (mean age, 75 years; 66% women) completed the trial (219 [88%] in the intervention group vs 218 [91%] in the control group).
• In the intervention group, 106 of 248 patients (43%) no longer filled prescriptions for inappropriate medication at 6 months vs 29 of 241 (12%) in the control group.
• Findings suggested that, in the intervention vs control group, discontinuation of inappropriate medication occurred among 63 of 146 sedative-hypnotic drug users (43.2%) vs 14 of 155 (9.0%), respectively; 19 of 62 glyburide users (30.6%) vs 8 of 58 (13.8%), respectively; and 19 of 33 nonsteroidal anti-inflammatory drug users (57.6%) vs 5 of 23 (21.7%), respectively.
• Due to the small sample size (n=12), analysis of the antihistamine drug class was not possible.
• They did not note any adverse events requiring hospitalization, although 29 of 77 patients (38%) who attempted to taper sedative-hypnotics reported withdrawal symptoms.