Pharmacist-led deprescribing to improve medication safety in older patients with hip fractures.

OBJECTIVES

Older patients with hip fractures face a patient safety threat due to multimorbidity, polypharmacy, potentially inappropriate medications (PIMs), and adverse drug reactions (ADRs, refer to adverse and unrelated reactions to drugs administered at normal doses for the prevention, diagnosis, treatment of diseases, or regulation of physiological functions). Therefore, optimizing drug therapy through drug review and prescription intervention is essential. The primary aim of this study was to assess the efficacy of pharmacist intervention in mitigating ADRs in older inpatients with hip fractures.

METHODS

This study employed a cross-sectional design. It included patients aged 75 years or older who were hospitalized for hip fractures and received multi-disciplinary treatment (MDT) between December 2021 and March 2024. Intervention comprised clinical pharmacist-led drug reviews focusing on PIMs and recommendations for minimizing any unnecessary medications during hospitalization. If the pharmacist-led intervention was accepted by the MDT, the inpatients were regarded as the intervention group; otherwise, they were regarded as the control group. The 2023 AGS/Beers criteria was utilized to assess the PIM status of inpatients with hip fractures. Medscape was used to evaluate drug-drug interactions (DDIs). Quantitative ADRs indicators, including hypoglycemia and hypotension, were assessed via the monitoring of biochemical parameters. Qualitative ADRs indicators, such as rash and delirium, were evaluated based on the observation of patients' clinical manifestations. Causality between drugs and ADRs was systematically assessed based on the standardized criteria established by the WHO-UMC (Uppsala Monitoring Center), and multivariate logistic regression was employed to identify the risk factors associated ADRs. The primary outcome was a significant reduction in the incidence of ADRs. Secondary outcomes included decreases in the prevalence of PIMs and the incidence of serious DDIs.

RESULTS

A total of 106 inpatients were included in the analysis. Following pharmacist-led drug review and deprescribing intervention, the mean number of prescribed medicines in the intervention group was significantly less than that in the control group [8.89 (SD, 2.20) vs. 11.38 (SD, 2.99), P < 0.01]. Additionally, the mean number of PIMs was significantly lower in the intervention group compared to the control group [1.11 (SD, 0.93) vs. 1.82 (SD, 1.30), P = 0.01]. Furthermore, the incidence of ADRs in the intervention group was significantly lower than that in the control group [17.14% (n = 6) vs. 69.01% (n = 49), P < 0.01]. The logistic regression further demonstrated that renal insufficiency (OR: 3.44, 95% CI: 1.22, 9.70, P = 0.02) was the independent risk factor for ADRs in older inpatients with hip fractures, and pharmacist-led deprescribing intervention significantly reduced the incidence of ADRs (OR: 0.14, 95% CI: 0.04, 0.48, P = 0.02).

CONCLUSIONS

The clinical pharmacist-led deprescribing intervention, designed to reduce the use of PIMs not only significantly decreased the number of prescribed drugs, but also markedly reduced the incidence of ADRs among older inpatients with hip fractures.