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Association of Deprescribing With Reduced Readmission to the Hospital
TAKE-HOME MESSAGE
- This large meta-analysis evaluated the possible benefits of deprescribing initiatives, described as careful medication reconciliation and cessation of likely unnecessary medications, in older adults with regard to hospital readmission. The results showed a significantly decreased short-term risk of readmission (HR, 0.84) at 1 to 3 months. The hazard ratio for readmissions beyond the 3-month period was 0.94; however, this was not statistically significant.
- This study supports the use of deprescribing initiatives to reduce the number of early hospital readmissions in older adults.
abstract
This abstract is available on the publisher's site.
Access this abstract nowINTRODUCTION
A recent systematic review and meta-analysis of inpatient studies1 found that medication reviews coupled with deprescribing interventions were associated with a small but significant reduction in rehospitalizations. The authors reported a hazard ratio (HR) of 0.92 (95% CI 0.85 to 0.99) derived from 19 randomized controlled trials (RCTs) and observational studies with outcomes measured between 1 and 12 months. That analysis provided much needed evidence in support of inpatient deprescribing initiatives. However, there are two key points for discussion. First, some important RCT data were not included by the search and selection strategy. Second, the inclusion of non-randomized data may increase bias. To increase the strength of the findings, we performed a sensitivity analysis restricted to RCTs and incorporated additional data.
Additional Info
Disclosure statements are available on the authors' profiles:
Deprescribing is associated with reduced readmission to hospital: An updated meta-analysis of randomized controlled trials
J Am Geriatr Soc 2024 Sep 05;[EPub Ahead of Print], TC Lee, É Bortolussi-Courval, LM McCarthy, EG McDonaldFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
A previous meta-analysis of 30 studies of deprescribing during hospitalization revealed a slight 8% reduction in hospital readmissions (HR, 0.92; 95% CI, 0.85–0.99).1 This study re-evaluated the data and addressed the limitations of the prior study by excluding observational studies and adding a previously eliminated randomized controlled trial, bringing the number of patients from 10,136 to 14,201. A reduced hazard of readmission at 1 to 3 months (HR, 0.84; 95% CI; 0.73–0.97) was found, which was not statistically significant when all durations of follow-up were included (HR, 0.94; 95% C, 0.87–1.01). Of note, the MedSafer software — the deprescribing software used in the added randomized trial — is owned by two of the four authors of this study.2
Deprescribing is challenging as patients and families often resist for fear of recurrent symptoms or having been told by previous prescribers to not stop a medicine. Discussing with the patient and family that the metabolism and elimination of medications change as one age may persuade them to try a dose reduction. Also, as cognition declines with dementia, fewer neurotransmitters are being produced by the failing brain. Thus, many medications to manage behaviors or symptoms may no longer be necessary. These meta-analyses cannot go into detail about the reasons for deprescribing or what percentage of inappropriate medications were prescribed.
Even though these studies showed only a small benefit, in an individual patient, it is worthwhile to suggest deprescribing inappropriate medications, as this can significantly improve the quality of life. Even if patients or their families do not agree with deprescribing at the first visit, it is worth readdressing to emphasize the importance and explain the reasons again. The Beers list is a good resource and the latest update from 2023 recommends the avoidance of anticholinergics, which include categories of muscle relaxants, antihistamines, and tricyclic antidepressants. Other categories include gabapentinoids, tramadol, benzodiazepines, and sleep medications.3
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