Alwidyan Tahani, Parsons Carole, Alqudah Abdelrahim, Al-Shudifat Abdel-Ellah, Al-Lozi Abdel-Rahman N, Riziq Khader Muna
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Damascus Hwy Road, P.O. Box 330127, Zarqa, 13133, Jordan.
School of Pharmacy, Queen's University Belfast, Belfast, UK.
Int J Clin Pharm. 2025 Sep 12. doi: 10.1007/s11096-025-02001-2.
Polypharmacy and potentially inappropriate medications (PIMs) are common among terminally ill older people and often persist until death, undermining comfort-focused care. While deprescribing is an effective strategy to optimise medicines use at the end of life, its timing is crucial. Delaying deprescribing until after hospice admission may diminish opportunities for comprehensive medication review during hospital-based care, when a full multidisciplinary team (MDT) and complete clinical records are available. Timely deprescribing during the final days of hospital-based care before hospice transition may better align pharmacotherapy with end-of-life goals and facilitate transition.
This study aimed to evaluate the impact of an MDT-led intervention delivered during the final days of hospital-based care before hospice transition on medication burden, PIM use, and symptom control prescribing.
This retrospective cohort study was conducted at a Jordanian tertiary hospital. Patients aged ≥ 65 years with life-limiting illnesses who were transitioned to hospice care between January and December 2022 were included. Medication data were extracted at baseline (seven days before MDT review) and post-intervention (in the final 24 h of hospital-based care). Deprescribing was categorised as proactive (planned discontinuation to prevent future harm) or reactive (triggered by an immediate clinical issue). Medication appropriateness was assessed using STOPPFrail version 2. Regimen complexity was evaluated using the Medication Regimen Complexity Index (MRCI).
Among 165 patients, polypharmacy (use of ≥ five medications) prevalence declined from 63.0% to 14.5% (P < 0.001), and the proportion receiving ≥ one PIM decreased from 91.6% to 34.0% (P < 0.001). The mean number of chronic medications declined by 4.5 (± 3.2), and MRCI scores decreased by 4.8 points (P < 0.001). Of 736 medications discontinued, 65.9% were proactively deprescribed. Use of symptom control medications, particularly opioids, increased significantly (from 5 to 64 prescriptions; P < 0.001). Regression analysis identified baseline polypharmacy, high MRCI, and dyslipidaemia as predictors of greater PIM reduction.
MDT-led deprescribing, implemented during the final days of hospital-based care before hospice transition, was associated with reduced medication burden and PIM use, alongside increased symptom-focused prescribing. These findings support the integration of structured, proactive deprescribing into hospital-based care to improve medication safety, enhance patient comfort, and facilitate continuity across care settings.
多重用药和潜在不适当用药（PIMs）在临终老年患者中很常见，并且常常持续到死亡，这有损以舒适为重点的护理。虽然减药是在生命末期优化药物使用的有效策略，但其时机至关重要。将减药推迟到临终关怀入院后，可能会减少在有完整多学科团队（MDT）和完整临床记录的医院护理期间进行全面药物审查的机会。在临终关怀过渡前的医院护理最后几天及时减药，可能会使药物治疗更好地与临终目标保持一致，并促进过渡。
本研究旨在评估在临终关怀过渡前的医院护理最后几天实施的MDT主导干预对药物负担、PIM使用和症状控制处方的影响。
这项回顾性队列研究在一家约旦三级医院进行。纳入了2022年1月至12月期间转至临终关怀护理的年龄≥65岁且患有危及生命疾病的患者。在基线（MDT审查前七天）和干预后（医院护理的最后24小时）提取用药数据。减药被分类为主动（计划停药以防止未来伤害）或被动（由即时临床问题触发）。使用STOPPFrail第2版评估用药适宜性。使用药物治疗方案复杂性指数（MRCI）评估治疗方案的复杂性。
在165名患者中，多重用药（使用≥五种药物）的患病率从63.0%降至14.5%（P<0.001），接受≥一种PIM的比例从91.6%降至34.0%（P<0.001）。慢性药物的平均数量减少了4.5（±3.2），MRCI评分降低了4.8分（P<0.001）。在停用的736种药物中，65.9%是主动减药的。症状控制药物的使用，尤其是阿片类药物，显著增加（从5张处方增至64张处方；P<0.001）。回归分析确定基线多重用药、高MRCI和血脂异常是PIM减少幅度更大的预测因素。
在临终关怀过渡前的医院护理最后几天实施的MDT主导的减药与药物负担和PIM使用的减少以及以症状为重点的处方增加有关。这些发现支持将结构化、主动的减药纳入医院护理，以提高用药安全性、增强患者舒适度并促进不同护理环境之间的连续性。
