Multi-disciplinary interventions including pharmacy support
The inclusion of a pharmacist into an outpatient clinic may be an enabler to improve deprescribing. The benefit of clinical pharmacists for successful deprescription has been highlighted in a number of studies in different clinical settings.15,56Additionally, studies looking at integrating clinical pharmacy services within outpatient clinics have already demonstrated benefits in terms of improving medication management and drug-related problems.57-59
A retrospective case-controlled study was identified that included a pharmacist in the multidisciplinary team of a geriatric outpatient clinic. This found the mean number of medications in the intervention group was able to be reduced by approximately eight medications (from 23 to a mean of 15 medications), with no change in the control group.28 However, it was noted that the intervention group had a higher number of medications at baseline, which may have given greater opportunity to deprescribe.
The idea of a designated outpatient polypharmacy clinic has been explored in a few small pilot studies and most included a pharmacist in the team.40-43,60 All studies demonstrated benefits, but had a high risk of bias. One study noted that the attendance of both a clinical pharmacologist and pharmacist throughout the intervention was unnecessary and recommended that a pharmacist-led service would be more time and cost efficient.40
One study was identified that examined the impact of a computer decision support tool containing both implicit guidelines and STOPP/START criteria to a multidisciplinary team at a preoperative review clinic.39 This study found that the number of PIMS decreased significantly. Some of the known barriers to successful deprescribing include time constraints, self-efficacy, and availability of resources.61 The availability of easy access to structured deprescribing tools has been highlighted as an enabler to deprescribing.