Grant: Project Grant

Polypharmacy, or the concomitant use of 5 drugs or more, is a serious health concern and affects more than half of Canadians aged 65 years and older. It is the number one identifiable risk factor for adverse drug events (ADEs), which are responsible for 27,000 hospital admissions annually in Canada and up to 20% of return visits to the hospital within 30 days of discharge. Many ADEs are preventable or ameliorable through interventions to reduce inappropriate prescribing. Our intervention applies an electronic set of criteria, previously designed and piloted by a group of Ontario geriatricians, internists, palliative care doctors and pharmacists, to identify potentially inappropriate medications (PIMs) in the hospitalized elderly. We will update existing software called MedSafer, which identifies PIMs and generates instructions for the patient and physician for safe discontinuation, with these criteria. Our study seeks to partially automate the deprescribing process and to demonstrate the efficacy of this type of intervention on important patient outcomes. At the time of hospitalization, the patient's medications, comorbidities, and a measure of frailty will be entered into the MedSafer software which will output an individualized and prioritized deprescription plan for the most responsible physician's consideration. Any subsequent medication changes will be transmitted to relevant community physicians. We will evaluate the impact of stopping PIMs on the occurrence of ADEs within 30 days of discharge, as compared to usual care. Nine hospitals from six university-affiliated medical centres across Canada will participate in this three year study. Our intervention could eventually be broadly deployed and ultimately become best practice for hospitalized elderly patients in Canada.