Pharmacists and deprescribing in palliative care settings

As pharmacists take on new responsibilities, researchers are studying the effects of pharmacists on interprofessional care teams.

The health care team and health system managers are increasingly recognizing the ability of pharmacists to analyze, review and consult on medications. With new responsibilities, now ranging from community pharmacies to interprofessional care teams, pharmacists provide medication information to improve health care outcomes.

A 2015 study reported that 20% of palliative care patients took 8 or more medications.1 With the increase in the number of drugs, the need for pharmacists increases to ensure safety.

As pharmacists take on new responsibilities, researchers are studying the effects of pharmacists on interprofessional care teams. The Journal of Palliative Medicine published a study to quantify the effect of pharmacists in a palliative care setting.2 Since patients in this setting are often on many medications, pharmacists recommend deprescribing medications for a better transition of patient care.

The researchers examined 45 hospital consultations by pharmacists during which they made 184 recommendations and the healthcare team successfully implemented 82% of them. Successful recommendations are those used during hospitalization and included in the discharge report. On average, prescribers stopped 3.3 drugs per patient.

The study noted that statins, anticoagulants and antiplatelets accounted for 30% of deprescribed drugs. The highest individual recommendation was vitamins and supplements at 20%.

Although pharmacists recommended stopping vitamins and supplements in 37 of 184 recommendations (20%), the healthcare team stopped them in only 27 patients. Other differences were observed with antiplatelet drugs, the discontinuation of which was recommended in 19 patients, but the healthcare team only implemented the recommendation in 13 patients.

The health care team agreed with most of the recommendations regarding antidiabetic drugs and antibiotics. Pharmacists recommended discontinuation in 24 patients and the healthcare team implemented the recommendation in 23 patients (96%). For antibiotics, the healthcare team used 100% of the recommendations (9 patients).

During deprescribing, pharmacists withdraw drugs with limited benefits, with more potential risks, and/or to reduce drug burden. The palliative care team sent 69% of patients back to hospice, so they withdrew drugs that were no longer supposed to benefit the patient.

This plan aligns with patient care goals to improve quality of life by reducing potential symptoms and medication burden. The most discontinued medications (i.e. vitamins/supplements, anti-diabetics and anti-platelets) did not control symptoms and did not provide benefit to the patient.

The investigators mentioned that the study did not have a comparison group without a pharmacist. The study could not conclude on the true effects of the pharmacist’s intervention because they do not know if these interventions would be carried out if the care team did not have a pharmacist.

Future research should include a comparison group and an analysis of barriers to acceptance of recommendations.

About the Author

Dylan DeCandia is a 2023 PharmD candidate at the University of Connecticut.

Resources

1. McNeil MJ, Kamal AH, Kutner JS, et al. The burden of polypharmacy in end-of-life patients. J Manage pain symptoms. 2016;51:178–183.e2.

2. Cook H, Walker KA, Lowry MF. Deprescribing interventions by clinical pharmacists in palliative care surrounding discussions of goals of care. J Palliat Med. 2022 June 14. doi: 10.1089/jpm.2021.0560. Epub ahead of print. PMID: 35704875.

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