both the patient and prescriber. The process of
deprescribing can often take longer than the
initiation of treatment, careful consideration at the
outset, consultation with the patient and regular
follow up may be perceived as a barrier due to time
constraints. 44 However, this might be contrary to
patient perception because patients on multiple
medications are, on the whole, quite willing to
consider a trial withdrawal of their medication. 46
Recommendations
Pharmacists, in view of their skills, knowledge, and
in-depth understanding of disease states and their
pharmacological management are able to advise
on appropriate deprescribing within the elderly
care multidisciplinary team (MDT). Pharmacist
contributions to the MDT, in the form of medication
reviews and contributions to the patient’s clinical
management plan, allow for the discontinuation
of unnecessary and sometimes harmful medicines.
Cost savings in the region of £135 million per year
could potentially be achieved through safe and
appropriate deprescribing in a care home setting. 47
These savings might actually be greater because this
sum does not take into account the efficiencies and
savings that occur due to the reduction in hospital
admissions secondary to adverse drug events.
In addition to undertaking medication reviews in
a holistic manner that addresses health and social
care needs, pharmacists can also contribute to the
process of deprescribing through the delivery of
education and training to increase the competence
and confidence of staff involved in this activity.
Pharmacists can also assist in the development of
guidelines and critical appraisal of current literature
relating to deprescribing, assimilation of the key
points and proposing recommendations to support
their application to a real life clinical setting. 47 There
is mounting evidence that can positively improve
the care of older patients through the process of
medicines optimisation. 48 Deprescribing may take
this a step further because the process will require
clinical expertise and potentially the use of tacit
knowledge to ensure patient safety, quality of life
and clinical outcomes are not compromised. 12
The involvement of pharmacists within the MDT
improves pharmaceutical care. 49,50 The acceptance
rates of pharmacist interventions, including dose
adjustments and deprescribing, can be as high as
80%, particularly in the elderly care setting. 51 This
demonstrates the evolving role of the pharmacist
within the MDT and the increasing importance of
collaborative working between specialist groups
involved in the care of adults. Pharmacists play a
pivotal role in influencing and driving deprescribing,
with a view to ensuring continuous review of
medicine regimes and reducing inappropriate
polypharmacy.
Conclusions
The evidence base to support the concept of
deprescribing is very much in its infancy, but is
rapidly growing in view of increased awareness
and understanding of the benefits, to both patients
and the National Health Service, through the
discontinuation of medications that are no longer
clinically indicated or unlikely to improve clinical
outcomes or prognosis. Fundamental to the process
of deprescribing is a paradigm shift in the way in
which healthcare providers view the prescribing
and administration of medications. Pharmacists,
with their level of knowledge around medicines are
well placed as a member of the MDT to identify and
initiate the deprescribing process.
24 | Issue 90 | 2018 | hospitalpharmacyeurope.com
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