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The MedSafer Study-Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial

McDonald EG, Wu PE, Rashidi B, et al. The MedSafer Study-Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial [published online ahead of print, 2022 Jan 18]. JAMA Intern Med. 2022;10.1001/jamainternmed.2021.7429. doi:10.1001/jamainternmed.2021.7429

A team of researchers investigated the impact of MedSafer, an electronic deprescribing tool based on electronic health record data and expert consensus. MedSafer is a personalized tool designed to identify potentially inappropriate medications and guide health care professionals through appropriate deprescription practices. Researchers conducted a cluster randomized clinical trial at 11 Canadian acute care hospitals, assessing patients 65 and older who were taking at least 5 medications. Organized into 3 clusters, 5,698 participants received care either during a control phase or an intervention phase. The control phase consisted of usual care (medication reconciliation), while the intervention phase provided individualized deprescribing reports to the patient’s care team, community pharmacy, and usual physician. The main outcome was the proportion of adverse drug events (ADEs) among patients within 30 days following hospital discharge. The key findings were:

1.     The MedSafer tool did not have a significant impact on reducing ADEs at 1-month after hospital discharge (ADEs occurred in 5.0% of control patients vs 4.9% of intervention patients, P>.05).

2.     MedSafer, however, did lead to statistically significant improvements in deprescribing for patients with 1 or more potentially inappropriate medication (PIMs) (Deprescribing occurred for 29.8% of control patients vs 55.4% of intervention patients, P<0.05).

The disappointing results about adverse drug events mirror findings from some other previous studies. As the authors note: “While our intervention identified numerous deprescribing opportunities, many were for low-risk nonbeneficial polypharmacy (e.g., nonstatin cholesterol-lowering medications or stool softeners). Deprescribing these medications is less likely to impact 30-day ADEs, but still has patient and societal value, such as avoiding excess cost, waste, and pill burden. When powering future studies of ADEs, interventions may need to focus specifically on high-risk medications, and the time frame for observing the outcome likely needs to be extended.”  Alternate ways of quantifying medication harms may also be useful to overcome the limitations of traditional methods for ascertaining adverse drug events.

Lead author Dr. Emily McDonald summarizes the study and key takeaways:

“We found that using our electronic decision support tool MedSafer reduced harmful and potentially unnecessary medications in older hospitalized patients with polypharmacy. After patients were discharged from the hospital, we were encouraged to learn that deprescribing was safe and most medications stayed stopped. We think deprescribing during an acute hospitalization is entirely feasible and very effective. Doctors and pharmacists should be encouraged to reevaluate polypharmacy during this very vulnerable event in the lives of patients.”

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