4CPS-016 Evaluation of a pharmacist-led deprescribing intervention in a polymedicated elderly population using the CLEO tool: optimising pharmacotherapy in chronic patients

<h3>Background and Importance</h3> Polypharmacy is a common healthcare problem in elderly patients. Pharmaceutical care aims to optimise medicine use and improve patients’ health outcomes by performing pharmaceutical interventions (PIs) that, ultimately, result in patients’ treatment changes. <h3>Aim and Objectives</h3> To evaluate the impact of PIs in institutionalised elderly patients (&gt;65 years), identifying potentially inappropriate drugs (contraindication, incorrect dosage, lack of indication or potential pharmacological interaction) and proposing their deprescription/adjustment of dosage. <h3>Material and Methods</h3> All patients who were admitted to the Sociosanitary Pharmacy Service of La Florida nursing home (Alicante, Spain) were included. Terminally ill patients were excluded. START/STOPP criteria, LESS-CHRON, Garfinkel’s geriatric/palliative good clinical practice algorithm, dysphagia register, Barthel scale, anticholinergic load calculators and electronic tools (MedStopper) were used. After analysing the patients‘ clinical situation, two hospital pharmacists agreed on the changes proposed to the prescriber and performed the analysis with CLEO tool. Disagreements were discussed until consensus was reached. <h3>Results</h3> The clinical records of 70 institutionalised patients with a 2:1 gender distribution (female: male) and a median age of 86.5 years were analysed. The median Barthel Scale score was 45 points. Dysphagia was detected in 9 patients (≈13%). Moderate anticholinergic risk was identified in 22 (31.4%) and low risk in 3 (≈4%) patients. A total of 50 treatment modifications (28 discontinuations and 22 dose reductions) were proposed, with an acceptance rate of 68% by the prescribing physician (20 discontinuations and 14 dose reductions). Of the discontinued drugs, 5 (20%) were analgesics, 3 (15%) antispasmodics and 2 (10%) vitamin D. Among the drugs with dose reductions 4 (29%) antidiabetics, 3 (21%) antidepressants and 2 (15%) antivertigo agents. When analysed using the CLEO tool, agreement was reached in 32 of the 34 initial ratings (agreement: 95%) for the clinical impact and 100% for the economic and organisational impact. Of the 34 changes, 30 (88%) were considered to have a moderate clinical impact and 4 (12%) were considered to have a major clinical impact on patients. At the economic level, all 34 (100%) interventions were found to reduce costs. At the organisational level, none of the interventions resulted in a significant logistical change. <h3>Conclusion and Relevance</h3> Pharmaceutical interventions aimed at pharmacotherapy optimisation promote clinical safety improving quality of care and efficiency of resources. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest