Eduard E. Vasilevskis, MD, MPH

The deprescribing intervention entitled Shed-MEDS was shown to be effective and safe for medication reduction at post-acute care (PAC) facility discharges, recent findings suggest.¹

Polypharmacy—the simultaneous use of several drugs for a single condition—is commonplace among older hospitalized patients, and while deprescribing as a strategy can lead to positive outcomes for these patients, there was not much evidence prior to this research into deprescribing interventions in hospital or PAC facilities.

This research was authored by Eduard E. Vasilevskis, MD, MPH, from the Center for Quality Aging at Vanderbilt University Medical Center.

“The primary objective of the intervention was to reduce overall medication count at hospital discharge and PAC facility discharge and to assess the maintenance of intervention effects 90 days after PAC facility discharge,” Vasilevskis and colleagues wrote.

Background

The investigators started their randomized, clinical study from March of 2016 to October of 2020 on the deprescribing intervention program titled Shed-MEDS, with 372 total patients recruited.

The study recruited patients aged 50 years-or-older with at least 5 prehospital medications who had been accepted into an academic medical center. The study participants also had to have been discharged from their center to 1 out of 22 possible PAC centers in Nashville.

The participants were randomized 1:1 to either the intervention arm to the control arm, and their close geographic proximity to the investigators’ research location was orchestrated to provide the team the ability to have a 90-day follow-up meeting.

The intervention arm were given the Shed-MEDS intervention and the control arm were given the typical care provided by a PAC center or a hospital.

The Shed-MEDS intervention involved a review of medication by either a pharmacist or by a nurse practitioner, with deprescribing recommendations agreed upon by the patient or surrogate and actions undertaken by the patient’s chosen facility itself.

The primary endpoint sought by the investigators was a medication count during the study participant’s discharge and a follow-up assessment after 90 days. Their secondary endpoints were the total number of possibly-inappropriate medications, adverse events (AEs), and the Drug Burden Index.

Findings

The investigators concluded in their study that the Shed-MEDS intervention proved to be efficacious and safe for patients’ reduction of their medication at discharge, with statistically significant treatment effects being reported.

Specifically, the intervention arm of the study at their discharge reported a mean of 14% fewer medications (mean ratio, 0.86; 95% CI, 0.80 to 0.93; P < .001).

They also had 15% fewer medications at the follow-up meeting at 90 days (mean ratio, 0.85; 95% CI, 0.78 to 0.92; P < .001) compared to the control arm.

The research team found that the patients also reported fewer exposures to possibly-inappropriate medications and reduced scores on the Drug Burden Index.

Regarding the other secondary endpoint assessed by the team, rates of AEs were essentially similar between both study arms (hazard ratio, 0.83; 95% CI, 0.52 to 1.30).

“In this randomized clinical trial, older adults requiring PAC after hospitalization experienced high levels of polypharmacy,” they wrote. “The patient-centered Shed-MEDS deprescribing intervention was found to be safe and effective in reducing the total medication burden at PAC facility discharge, with a sustained effect of up to 90 days after discharge.”

The research team added that researchers should examine patients’ outcomes as well as the longer-term clinical outcomes after deprescribing.

References:

1. Vasilevskis EE, Shah AS, Hollingsworth EK, et al. Deprescribing Medications Among Older Adults From End of Hospitalization Through Postacute Care: A Shed-MEDS Randomized Clinical Trial. JAMA Intern Med. Published online February 06, 2023. doi:10.1001/jamainternmed.2022.6545