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.