Physician-led interventions
There were 3 RCTs that looked at Physician-led medication changes occurring as a result of a comprehensive geriatric assessment (CGA).26,32,39 All showed an improvement in appropriateness of medication as demonstrated by a decrease in use of PIMS or improvement in MAI. However, a reduction in total medication count was not achieved in the retrospective study completed by Lampela et al. with the overall medication burden increasing by a mean of 0.5 medications at 12 months.26 Another retrospective evaluation of CGA medication changes also noted an increase in medications.27 The increase in medications noted in the retrospective studies suggested that deprescribing may not be a main priority during routine assessments. A more recently completed performance improvement project at an outpatient geriatric clinic demonstrated that deprescribing was possible by geriatricians at routine patient encounters with integration of a deprescribing algorithm.25 This study was physician-led and implemented, but concluded that deprescribing would be more positively influenced by systematic multidisciplinary medication review. Another study reviewed the challenges of physician-led deprescribing of inappropriate medications within geriatric outpatient clinics. The data collected from this pilot study had notable limitations; however, it was interesting to note that the major barrier cited was establishing an accurate medication history – a challenge that may be overcome by pharmacist inclusion.55