Projects

Project Description

Description:

a) Background: Polypharmacy is common in the elderly, as this age group often suffers from multimorbidity, such as cardiovascular disease and diabetes that require multiple medications for treatment and prophylaxis

(1). Exposure to multiple medications is associated with increased risk of serious adverse events, including falls, cognitive impairment, functional decline, hospitalization, increased length of hospital stays and death (2). Also, a developing country like India, most of the patients who visit the public tertiary health care centres are from lower socioeconomic strata and/or rural areas, and not literate enough to comprehend the instructions written by the doctor in the prescription or given verbally in the short consultation due to time constraints. Pharmacies also usually are unable to fill this information gap.  In addition, some of prescribed drugs may be potentially inappropriate medications (PIM), defined as a medication that should not be prescribed because the risk of adverse events outweighs the clinical benefit, especially when more effective alternatives are available  (3). It is therefore necessary to periodically review medication intake of the elderly and discontinue or reduce the dose of the ones that may lead to adverse effects, drug interactions or are no longer required for the patient. This is termed as deprescribing. Deprescribing is defined as a process of medication withdrawal, supervised by a health care professional, with the goal of managing polypharmacy and improving outcomes (4).  In addition to avoiding unwanted adverse effects and interactions, deprescribing can lead to reduced cost of therapy, which is important since most medication costs are met out of pocket in India.

There are many tools for deprescribing, including implicit and explicit tools.(5) But none of these tools has been developed for the Indian context, which differs in terms of a high prevalence of diabetes with or without hypertension requiring multiple drugs, widespread use of fixed dose combinations (FDCs), use of medicines from different systems of medicines, and high out of pocket expenditure on medicines.

We therefore propose to use the available deprescribing tools to develop a deprescribing tool for the Indian elderly population and evaluate its impact on prescription quality and risk minimization by averting potential adverse drug reactions and interactions.