Medication Deprescribing in Older Patients with Multiple Long Term Conditions

<p dir="ltr">This project comprises a comprehensive study into the effects of medication deprescribing across the UK’s older population. First, a systematic review was carried out to investigate current deprescribing practices and evaluate outcomes and adverse events associated with deprescribing of preventive medications in older patients with either an end-of-life designation or residing in long-term care facilities with cardiometabolic conditions. The studies reported no significant changes in laboratory values or adverse outcomes but did find mixed outcomes for hospitalisations along with a slight increase in mortality rates when comparing the intervention group to the control groups.</p><p dir="ltr">The next work package was carried out using data from the Clinical Practice Research Datalink (CPRD) which determined the prevalence, trends, and patterns in the deprescription of preventive medications across primary care centres in the UK for patients living with multiple long term conditions (MLTCs) who were assigned an end-of-life designation. The study found that only a small handful of patients underwent deprescribing interventions in their final twelve months of life with the findings being consistent across all medication groups assessed. A budget impact model was also produced to assess the potential cost saving efforts at the system-level. </p><p dir="ltr">The final work package for this project comprised of two parts: a systematic review identifying the attitudes and perceptions of deprescribing efforts from the perspective of the healthcare professional (HCP) and a mixed methods study which assessed the barriers and enablers toward deprescribing efforts through the use of the Healthcare Professionals Attitudes Towards Deprescribing (HATD) tool. The systematic review found that most HCPs were willing to initiate deprescribing strategies and stated the importance of such interventions, however many felt inexperienced and lacked the required knowledge to feel comfortable doing so, with the results of the mixed methods study mirroring those found in the literature.</p>