The potential for deprescribing in care home residents with Type 2 diabetes
Int J Clin Pharm
The potential for deprescribing in care home residents with Type 2 diabetes
Lillan Mo Andreassen 0 1 2 3
Reidun Lisbet Skeide Kjome 0 1 2 3
Una Ørvim Sølvik 0 1 2 3
Julie Houghton 0 1 2 3
James Antony Desborough 0 1 2 3
0 School of Health Sciences, University of East Anglia , Norwich Research Park, Norwich NR4 7TJ , UK
1 Department of Global Public Health and Primary Care, University of Bergen , Kalfarveien 31, PO Box 7804, 5020 Bergen , Norway
2 & Lillan Mo Andreassen
3 School of Pharmacy, University of East Anglia , Norwich Research Park, Norwich NR4 7TJ , UK
Background Type 2 diabetes is a common diagnosis in care home residents that is associated with potentially inappropriate prescribing and thus risk of additional suffering. Previous studies found that diabetes medicines can be safely withdrawn in care home residents, encouraging further investigation of the potential for deprescribing amongst these patients. Objectives Describe comorbidities and medicine use in care home residents with Type 2 diabetes; identify number of potentially inappropriate medicines prescribed for these residents using a medicines optimisation tool; assess clinical applicability of the tool. Setting Thirty care homes for older people, East Anglia, UK. Method Data on diagnoses and medicines were extracted from medical records of 826 residents. Potentially inappropriate medicines were identified using the tool 'Optimising Safe and Appropriate Medicines Use'. Twenty percent of results were validated by a care home physician. Main outcome measure Number of potentially inappropriate medicines. Results The 106 residents with Type 2 diabetes had more comorbidities and prescriptions than those without. Over 90 % of residents with Type 2 diabetes had at least one potentially inappropriate medication. The most common was absence of valid indication. The physician unreservedly endorsed 39 % of the suggested deprescribing, and would consider discontinuing all but one of the remaining medicines following access to additional information. Conclusion UK care home residents with Type 2 diabetes had an increased burden of comorbidities and prescriptions. The majority of these patients were prescribed potentially inappropriate medicines. Validation by a care home physician supported the clinical applicability of the medicines optimisation tool.
Care homes; Deprescribing; Medicines optimisation tool; Pharmacists; Potentially inappropriate medicines; Type 2 diabetes mellitus
Impacts of practice
•
•
The results from this study suggest that care home
residents with Type 2 diabetes have a higher burden of
comorbidities and polypharmacy than residents without
diabetes, thereby having increased risk for potentially
inappropriate prescribing.
The evidence-based, pragmatic medicines optimisation
tool used in this study allows pharmacists to identify
medicines eligible for deprescribing for care home
residents with Type 2 diabetes, thus reducing
polypharmacy and potentially adverse events following from it.
Introduction
In the UK, care homes for older people provide
accommodation and nursing or personal care to those who need it.
These institutions are staffed 24 h a day, with or without
qualified nursing staff, and are referred to as nursing homes
and residential homes respectively. Care home residents
generally have a limited life expectancy [
1
] and experience
high levels of disability, comorbidity and polypharmacy
[
2
]. Non-insulin-dependent diabetes, also known as Type 2
diabetes mellitus (T2DM), is reported to be among the ten
most common diagnoses, affecting 15 % of the care home
population [
2
].
T2DM is associated with a range of comorbidities and
complications [
3, 4
], deteriorating health and reducing
quality of life. In the general older population, diabetes has
been identified as a predictor of multiple medicine use [5]
and an independent risk factor for being prescribed
potentially inappropriate medicines or combinations of
these [
6, 7
]. Unnecessary or inappropriate medicines can
cause adverse events and additional suffering in this
already vulnerable group of patients. It is argued that
people with diabetes who suffer from multiple
comorbidities, cognitive impairment or reside in a long-term
nursing facility may experience limited or uncertain benefit
from diabetes treatment [
8, 9
]. Concerns about
overtreatment with blood glucose lowering medicines have been
reported [
10, 11
] and a Swedish study suggests that
diabetes medicines can be safely reduced or withdrawn in the
majority of these residents [11]. These findings indicate
that the potential for deprescribing should be investigated
to a greater extent in this population.
Deprescribing is defined by Reeve et al. [
12
] as «the
process of withdrawal of an inappropriate medication,
supervised by a health care professional with the goal of
managing polypharmacy and improving outcomes».
Deprescribing is increasingly acknowledged as an
imp (...truncated)