Deprescribing in older community patients

A randomised controlled trial to test the effectiveness of a pharmacist led deprescribing intervention focused on sedative and anticholinergic medications will be conducted in the Canterbury region of New Zealand. Participants are community dwelling older adults who have had an interRAI assessment within the previous twelve months. Participants are provided with an ethics approved Participant Information Sheet and Consent form; no other information is provided to the participant. A frailty index developed for interRAI Homecare and Contact assessments will be used to place participants into one of three frailty strata. The one-off intervention will be delivered by New Zealand registered pharmacists trained in the peer-reviewed deprescribing guidelines and processes used for this trial. The pharmacist will first review the participant’s medication history in their home. Following randomization into the intervention arm the pharmacist will further inquire participants’ experience, medical details and identify options for changes to sedative and anticholinergic medications. These options will be communicated in writing to the participant’s general practitioner for follow up. At least 6 months following the initial medication review, a different pharmacist will again record medication use in the participant’s home. The cumulative use of anticholinergic and sedative medications for each participant will be quantified using the drug burden index. HDEC approved participant information sheet and consent form The primary outcome will be the change in the participants’ cumulative use of anticholinergic and sedative medicines from prior to, to at least six months following the deprescribing intervention. Secondary outcomes will include the rate of hospitalisation (number of emergency department visits, unplanned hospital admissions) and entry into residential care during the study period. An internal peer review process will ensure consistency and fidelity of the intervention.