Conclusion
A specialist outpatient clinic provides an additional setting to review
for inappropriate medication use, especially for older patients who are
often co-morbid and at significant risk of polypharmacy. Deprescribing
for hospital inpatients may not be a focus during an acute admission,
and in primary care general practitioners might be reluctant to cease
medications prescribed elsewhere. A specialist outpatient clinic
provides a setting for experts to appraise medical conditions that might
change the risk-benefit profile of existing medications. While the
evidence for deprescribing interventions in outpatient clinics is very
limited, the addition of a pharmacist and use of validated medication
assessment tools appear to be significant enablers. The most effective
way to incorporate the deprescribing intervention has not been
established and requires more research, but it might involve a
multidisciplinary clinic that includes a pharmacist or a targeted
pharmacist-led, physician-implemented intervention. It is also possible
that the existence of a specific polypharmacy service could help to
break the lack of intervention for patients with high medication
burdens. Further research is recommended to confirm if this approach is
effective, if the changes can be maintained, and if this approach
translates to clinical benefit.