Physician-led interventions
There were 3 RCTs that looked at Physician-led medication changes
occurring as a result of a comprehensive geriatric assessment
(CGA).26,32,39 All showed an improvement in
appropriateness of medication as demonstrated by a decrease in use of
PIMS or improvement in MAI. However, a reduction in total medication
count was not achieved in the retrospective study completed by Lampela
et al. with the overall medication burden increasing by a mean of 0.5
medications at 12 months.26 Another retrospective
evaluation of CGA medication changes also noted an increase in
medications.27 The increase in medications noted in
the retrospective studies suggested that deprescribing may not be a main
priority during routine assessments. A more recently completed
performance improvement project at an outpatient geriatric clinic
demonstrated that deprescribing was possible by geriatricians at routine
patient encounters with integration of a deprescribing
algorithm.25 This study was physician-led and
implemented, but concluded that deprescribing would be more positively
influenced by systematic multidisciplinary medication review. Another
study reviewed the challenges of physician-led deprescribing of
inappropriate medications within geriatric outpatient clinics. The data
collected from this pilot study had notable limitations; however, it was
interesting to note that the major barrier cited was establishing an
accurate medication history – a challenge that may be overcome by
pharmacist inclusion.55