Abstract
Background and objective
Psychotropic medications are frequently prescribed during acute care, even in older patients. They represent a risk for inappropriate long-term use and increase the overall risk of morbidity and mortality in this population. Our project aimed to evaluate the feasibility of a psychotropic medication stewardship program led by pharmacists.
Methods
We conducted a prospective, observational pilot study in patients aged 75 years and older, admitted to a surgical unit with at least one active prescription of a psychotropic medication (antipsychotic, benzodiazepine or non-benzodiazepine receptor agonist). Each psychotropic medication was assessed for potential deprescription, and if eligible, a recommendation from the stewardship pharmacist was made to the medical team.
Results
Among 183 patients, 93.4% were eligible for a potential deprescription. A total of 298 prescriptions were evaluated by the stewardship pharmacists, of which 57.7% were antipsychotics, 22.8% were benzodiazepines and 19.5% were non-benzodiazepine receptor agonists. Most of the assessed prescriptions were started during current hospitalization (62.7%). The median time required for the intervention per patient was 17 min 30 s. The stewardship pharmacists made 192 suggestions for 258 eligible prescriptions, with 69.8% being deprescription recommendations. Of all the deprescription suggestions, 75.4% were accepted by the medical team and 84.8% of those accepted persisted at discharge.
Conclusion
The implementation of a pharmacist-led psychotropic medication stewardship program on surgical units in our hospital is feasible and is a promising approach to improve geriatric care.
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Acknowledgements
We would like to thank all the clinical pharmacists on the surgical units who collaborated with the stewardship pharmacists during this study.
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Funding
Funding was granted by the Faculty of Pharmacy of the University of Montreal for statistical analyses.
Conflicts of interest
Marie d’Amours, Farah Ettis, Lauriane Ginefri, Johnny Lim and Angela-Sinlan Lin Poo Yuan, Jennifer Fontaine, Dana Wazzan and David Williamson declare that they have no conflicts of interest. Vincent Dagenais-Beaulé has received fees for consulting from Abbvie, HLS therapeutics and Otsuka for unrelated work, and speaker fees from Abbvie, HLS therapeutics, Ostuka and Jansen for unrelated work.
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The data generated and analyzed during the current study are available from the corresponding author on reasonable request.
Ethics approval
This study has been approved by the Quality, Transformation, Evaluation, Performance and Ethics Department of the CIUSSS West-Central Montreal. This quality improvement project falls under Article 2.5 of the TriCouncil Policy, statement 2, 2018 and therefore Research Ethics Board approval was not required. As quality improvement research, participants’ consent was not required and access to their charts was granted by the Director of Professional Services of the institution. Patients enrolled were assigned an identification number by the pharmacy at the time of inclusion. Confidential information was anonymized and kept in a secured electronic file protected by a password, solely accessible by the stewardship pharmacists leading the project. The file was destroyed at the end of follow-up to preserve patients’ confidentiality.
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Author contributions
All authors contributed to the study conception and design. Material preparation, data collection and analyses were performed by Marie d’Amours, Farah Ettis, Lauriane Ginefri, Johnny Lim and Angela-Sinlan Lin Poo Yuan. The first draft of the manuscript was written by Marie d’Amours, Farah Ettis, Lauriane Ginefri, Johnny Lim and Angela-Sinlan Lin Poo Yuan. All authors commented and edited the manuscript. All authors read and approved the final version of the manuscript and agree to be accountable for the work.
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40266_2023_1063_MOESM1_ESM.pdf
Supplementary file1 The supplementary information available online contains the following : (1) the trajectory of patients and prescriptions throughout the study, (2) additional characteristics of patients and prescriptions evaluated and (3) results of the sensitivity analyses not presented in this article. (PDF 881 KB)
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d’Amours, M., Ettis, F., Ginefri, L. et al. The PROMISING Project: A Pilot Study to Improve Geriatric Care Through a Pharmacist-Led Psychotropic Stewardship Program. Drugs Aging 40, 1037–1045 (2023). https://doi.org/10.1007/s40266-023-01063-z
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DOI: https://doi.org/10.1007/s40266-023-01063-z