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Developing a model for deprescribing in hospital

Developing a model to support practitioners to deprescribe medicines for older people during hospital admission

Sion Scott, University of East Anglia 

Better healthcare and living conditions have led to people living longer. Most healthy people born today are expected to live well into their 80s. This has led to more people developing long-term health conditions like high blood pressure. Treating long term conditions often involves a prescription for a medicine. People who have more than one condition can end up taking a large number of medicines.

Most medicines have benefits and problems and the balance between these can change over a person’s lifetime. This means that older people may no longer be suited to some medicines prescribed to them when they were younger. This is because the medicines are more likely to give them problems such as side-effects which can lead to a stay in hospital. A process called ‘deprescribing’ involves patients and healthcare staff looking at medicines together and stopping ones which might have more risks than benefits.

General Practitioners (GPs), patients and informal caregivers like a spouse have told researchers that they support the idea of deprescribing medicines that might do more harm than good but have said they also have some concerns. GPs have said that deprescribing might be hard because they have little time with patients during appointments and monitoring the effects of stopping medicines could be difficult. They have also said they would need advice from other healthcare staff like hospital doctors and pharmacists.

Researchers think that deprescribing with patients in hospital might be a good idea because hospitals have some of the things that GPs have said that they need for deprescribing. Hospitals might also be a safe place to try out deprescribing because patients are closely monitored and specialist healthcare staff are available.

Some research looking into deprescribing in hospitals has been done, but researchers don’t know what healthcare staff and patients in hospitals think about deprescribing. Also, if healthcare staff and patients think that deprescribing in hospital is a good idea, it is unclear how this should work.

Aim

To understand how deprescribing in hospital should happen

Objectives

  1. What deprescribing happens already in hospital?
  2. What are the opinions of patients, informal caregivers and healthcare staff towards deprescribing?
  3. How should deprescribing be done in hospital?

For objective 1, the researcher will look at electronic records of medicines that are stopped in hospital to see which medicines are most often stopped and which specialities are doing the most deprescribing.

For objective 2, the researcher will meet with healthcare staff like doctors and pharmacists and understand what they think about deprescribing and what the challenges might be to doing this in hospital. A questionnaire designed to understand what people think about deprescribing will be given to patients and caregivers in hospital to see what they think.

The answers from objectives 1 and 2 will help the researcher understand how deprescribing in hospital should happen and will be used to give healthcare staff suggestions about how to do it.

The project was awarded funding in July 2017 and ran from August 2018 to September 2019.

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