McConeghy, K. W., Cinque, M., White, E. M., Feifer, R. A., Blackman, C., Mor, V., Gravenstein, S., & Zullo, A. R. (2021). Lessons for deprescribing from a nonessential medication hold policy in US nursing homes. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.17512
temporarily hold potentially unnecessary medications, a unique opportunity was presented to deprescribing researchers. Dr. Kevin McConeghy and colleagues conducted a retrospective cohort study using electronic health record data to describe rates of held and discontinued medications as a result of the temporary policy.
By the end of the hold policy, more than half (54%) of nonessential medications were permanently discontinued. Multivitamins were most likely to be held, followed by histamine-2 receptor antagonists, antihistamines, and statins. Additionally, over 50% of the variability in whether medications were discontinued is explained by facility-level rather than resident-level characteristics.
Senior author Dr. Andrew Zullo discusses his key insights…
“We learned from this work that 1) system-level (e.g., nursing home chain-level) deprescribing interventions can be conducted successfully and that 2) temporary medication hold policies may directly inform the design of future system-level deprescribing interventions. Person-level deprescribing focused on patient goals, preferences, and what matters most to the person will remain essential when deprescribing, but we hope that our results can help to spur the development and testing of more system-level deprescribing initiatives. Combining both person-level and system-level approaches to maximize the scale at which deprescribing occurs should be a focus of future research efforts.”