WS1: Deprescribing as a part of clinical medication review to attain health related goals and reduce adverse drug events

Henk-Frans Kwint, SIR Institute for Pharmacy Practice and Policy/ Academic Pharmacy Stevenshof
Valerie Meijvis, SIR Institute for Pharmacy Practice and Policy/
Valerie Meijvis, SIR Institute for Pharmacy Practice and Policy

Background:

Studies of medication reviews in community pharmacies have shown positive effects on process- and intermediate outcomes such as resolution of drug related problems (DRPs). However, the effects on clinical outcomes (mortality, hospital admissions and quality of life) are variable. Medication review with a more focussed approach on patient’s needs, concerns and complaints could possibly have more effect on health-related quality of life. For example, reducing adverse drug events may improve the health-related quality of life. One approach to handle medication use, where the benefit-risk ratio is negative, has been called “deprescribing”. Deprescribing is the process of tapering, stopping, discontinuing, or withdrawing drugs, with the aim of improving health-related outcomes
In the Netherlands, a new study with more emphasis on patient’s needs and complaints within medication review has been launched. This so- called “DREAMeR-study” (Drug use Reconsidered in the Elderly using goal Attainment scales during Medication Review) aims to investigate whether a clinical medication review focused on experienced health complaints and personal expectations of medication could improve the health-related quality of life of patients aged 70 years or older and using at least seven chronic medications. During the clinical medication reviews in this study, specific attention will be paid to adverse drug events and patients’ goals related to their medication. Reaching these goals will be measured with goal attainment scales. An example of a problem measured with a Goal Attainment Scale can be found in figure 1.

Target audience:

The aim of the workshop is to provide participants more clinical knowledge of adverse drug events and how to define goals related to health and medication in concordance with older patients.

Learning Objectives:

After attending this workshop participants should be able to
• Describe the most frequent adverse drug events in older people with polypharmacy which have a negative impact on quality of life.
• Discuss possible health-related goals in a pharmaceutical care plan with the patient during a clinical medication review using goal attainment scales
• Describe the steps of a deprescribing protocol within the context of a patient-oriented medication review, in particular assess each drug in regard to its current or future benefit potential compared with current or future harm or burden

Content and Structure:

Content & Structure of the workshop:
• Introduction 20 min
Short presentation of adverse drug events, goal attainment scales and deprescribing and objectives of the workshop
• Interactive quiz with smart phone 45 min
Participants will be invited to use their smart phone to answer questions about cases of adverse drug events and goal attainment scales in older patients with polypharmacy.

• Practicing with a patient case in small groups 45 min
Participants will watch a video where a pharmacist interviews an older patient with polypharmacy. After the video, participants will work in small groups. They will receive medical and medicine information and have to set up in a pharmaceutical care plan using goal attainment scales and using a deprescribing protocol. The pharmaceutical care plans will be discussed plenary.

• Take home messages 10 min
Summary of the information presented and take home messages

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