Goh Sheron Sir Loon, Lai Pauline Siew Mei, Ramdzan Siti Nurkamilla, Tan Kit Mun, Goh Amanda Mae Ching, Tan Maw Pin
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia.
Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
PLoS One. 2025 Jun 3;20(6):e0324565. doi: 10.1371/journal.pone.0324565. eCollection 2025.
The concept of deprescribing is gaining traction among clinicians as a formalized approach to improving medication safety for older persons. It has been found to be safe and effective in reducing medication burden. However, its implementation remains challenging. Most research has been conducted in high-income countries, with limited prospective data on deprescribing outcomes in outpatient care settings for older adults in low- and middle-income countries (LMICs). Therefore, evaluating local deprescribing interventions is essential to produce evidence on their effectiveness in older populations. Our study aimed to assess the effectiveness of the Physician-Pharmacist Partnership Intervention for Deprescribing (P3ID) among older persons attending a falls and syncope clinic.
This randomised controlled trial will be conducted at a teaching hospital in Kuala Lumpur, Malaysia. Participants will involve individuals aged ≥60 years with at least one chronic disease requiring pharmacological treatment, attending the falls and syncope clinic with ≥1 potentially inappropriate medication (PIM) undergoing systematic multidomain assessment and attending physicians at the clinic. The joint pharmacist-physician intervention comprises five steps: 1) PIM identification, 2) decision on cessation and prioritisation, 3) medication withdrawal, 4) monitoring and support, 5) and documentation.
The P3ID trial tests the hypothesis that a jointly led pharmacist-physician intervention in an outpatient will reduce the total number of medications, improve medication adherence, reduce falls and improve patients' and doctors' satisfaction towards pharmacist services. Findings from this study would inform future deprescribing practices, particularly in LMIC, pertaining to fall prevention as well as aid the development of future deprescribing interventions in other settings.
减药方案作为一种改善老年人用药安全的正规方法，在临床医生中越来越受到关注。已发现该方案在减轻用药负担方面安全有效。然而，其实施仍具有挑战性。大多数研究是在高收入国家进行的，关于低收入和中等收入国家（LMICs）门诊环境中老年人减药方案结果的前瞻性数据有限。因此，评估当地的减药干预措施对于证明其在老年人群中的有效性至关重要。我们的研究旨在评估药师 - 医生联合减药干预方案（P3ID）对就诊于跌倒与晕厥门诊的老年人的有效性。
这项随机对照试验将在马来西亚吉隆坡的一家教学医院进行。参与者将包括年龄≥60岁、患有至少一种需要药物治疗的慢性病、就诊于跌倒与晕厥门诊且有≥1种潜在不适当用药（PIM）、正在接受系统多领域评估的个体以及该门诊的主治医生。药师 - 医生联合干预包括五个步骤：1）识别潜在不适当用药；2）决定停药及确定优先顺序；3）撤药；4）监测与支持；5）记录。
P3ID试验检验了以下假设：在门诊中由药师和医生共同主导的干预措施将减少药物总数、提高用药依从性、减少跌倒，并提高患者和医生对药师服务的满意度。本研究的结果将为未来的减药实践提供信息，特别是在低收入和中等收入国家与预防跌倒相关的实践，并有助于在其他环境中开发未来的减药干预措施。
