Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review: the LeMON study (Less Medicines in Older Patients in the Netherlands), a cluster randomized controlled trial.
Jamila Abou, Petra J M Elders, Danielle Huijts, Rob van Marum, Jacqueline Hugtenburg
{"title":"Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review: the LeMON study (Less Medicines in Older Patients in the Netherlands), a cluster randomized controlled trial.","authors":"Jamila Abou, Petra J M Elders, Danielle Huijts, Rob van Marum, Jacqueline Hugtenburg","doi":"10.1007/s11096-025-01863-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Deprescribing inappropriate cardiovascular and antidiabetic medication has been shown to be feasible and safe. Healthcare providers often perceive the deprescribing of cardiovascular and antidiabetic medication as a challenge and therefore it is still not widely implemented in daily practice.</p><p><strong>Aim: </strong>The aim was to assess whether training focused on conducting a deprescribing-oriented clinical medication review (CMR) results in a reduction of the inappropriate use of cardiovascular and antidiabetic medicines.</p><p><strong>Method: </strong>A cluster randomized controlled trial involving 20 community pharmacists, who conducted a clinical medication review in 10 patients. The intervention group received training on deprescribing. Patients 70 years or older with polypharmacy having a systolic blood pressure below 140 mmHg and using antihypertensive medication and/or an HbA1c level below 54 mmol/mol and using antidiabetic medication, were included. Follow-up took place within 4 weeks (T1) and after 3 months (T2). The primary outcome measure was the proportion of patients with one or more cardiovascular and antidiabetic medicine deprescribed within 3 months after the CMR (T2).</p><p><strong>Results: </strong>A total of 71 patients in the intervention group and 69 patients in the control group were included. At T2, 32% of patients in the intervention group and 26% in the control group (OR 1.4, CI 0.65-2.82, p = 0.413) had one or more cardiovascular or antidiabetic medicines discontinued. Regarding any medication, these percentages were 51% and 36%, (OR 1.8, CI 0.92-3.56, p = 0.085) respectively.</p><p><strong>Conclusion: </strong>Increased awareness and ability of community pharmacists to deprescribe medication and use of general practitioners' data, led community pharmacists and general practitioners to successfully conduct a more deprescribing-focused CMR in daily practice. Further research is needed to assess the necessity of additional training to optimize the deprescribing of cardiovascular and antidiabetic medication. The study was registered at The Netherlands Trial Register (registration no: NL8082).</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":"717-725"},"PeriodicalIF":3.2000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125148/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Clinical Pharmacy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11096-025-01863-w","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/23 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Deprescribing inappropriate cardiovascular and antidiabetic medication has been shown to be feasible and safe. Healthcare providers often perceive the deprescribing of cardiovascular and antidiabetic medication as a challenge and therefore it is still not widely implemented in daily practice.
Aim: The aim was to assess whether training focused on conducting a deprescribing-oriented clinical medication review (CMR) results in a reduction of the inappropriate use of cardiovascular and antidiabetic medicines.
Method: A cluster randomized controlled trial involving 20 community pharmacists, who conducted a clinical medication review in 10 patients. The intervention group received training on deprescribing. Patients 70 years or older with polypharmacy having a systolic blood pressure below 140 mmHg and using antihypertensive medication and/or an HbA1c level below 54 mmol/mol and using antidiabetic medication, were included. Follow-up took place within 4 weeks (T1) and after 3 months (T2). The primary outcome measure was the proportion of patients with one or more cardiovascular and antidiabetic medicine deprescribed within 3 months after the CMR (T2).
Results: A total of 71 patients in the intervention group and 69 patients in the control group were included. At T2, 32% of patients in the intervention group and 26% in the control group (OR 1.4, CI 0.65-2.82, p = 0.413) had one or more cardiovascular or antidiabetic medicines discontinued. Regarding any medication, these percentages were 51% and 36%, (OR 1.8, CI 0.92-3.56, p = 0.085) respectively.
Conclusion: Increased awareness and ability of community pharmacists to deprescribe medication and use of general practitioners' data, led community pharmacists and general practitioners to successfully conduct a more deprescribing-focused CMR in daily practice. Further research is needed to assess the necessity of additional training to optimize the deprescribing of cardiovascular and antidiabetic medication. The study was registered at The Netherlands Trial Register (registration no: NL8082).
背景：不适当的心血管和降糖药物处方已被证明是可行和安全的。医疗保健提供者通常认为心血管和抗糖尿病药物的处方是一个挑战，因此它仍然没有在日常实践中广泛实施。目的：目的是评估以减少处方为导向的临床用药审查（CMR）为重点的培训是否能减少心血管和抗糖尿病药物的不当使用。方法：采用聚类随机对照试验，20名社区药师对10例患者进行临床用药回顾。干预组接受减药培训。患者年龄≥70岁，收缩压低于140 mmHg，正在使用降压药物和/或HbA1c水平低于54 mmol/mol，正在使用降糖药物。随访时间分别为4周（T1）和3个月（T2）。主要结局指标是CMR后3个月内服用一种或多种心血管和降糖药物的患者比例（T2）。结果：干预组71例，对照组69例。T2时，干预组32%的患者和对照组26%的患者（OR 1.4, CI 0.65-2.82, p = 0.413）停用一种或多种心血管或降糖药物。对于任何药物，这些百分比分别为51%和36% （OR 1.8, CI 0.92-3.56, p = 0.085）。结论：社区药师解除处方的意识和能力的提高以及对全科医生数据的利用，使社区药师和全科医生在日常实践中成功地开展了以解除处方为重点的CMR。需要进一步的研究来评估额外培训的必要性，以优化心血管和抗糖尿病药物的处方。该研究已在荷兰试验登记处注册（注册号：NL8082）。
期刊介绍：
The International Journal of Clinical Pharmacy (IJCP) offers a platform for articles on research in Clinical Pharmacy, Pharmaceutical Care and related practice-oriented subjects in the pharmaceutical sciences.
IJCP is a bi-monthly, international, peer-reviewed journal that publishes original research data, new ideas and discussions on pharmacotherapy and outcome research, clinical pharmacy, pharmacoepidemiology, pharmacoeconomics, the clinical use of medicines, medical devices and laboratory tests, information on medicines and medical devices information, pharmacy services research, medication management, other clinical aspects of pharmacy.
IJCP publishes original Research articles, Review articles , Short research reports, Commentaries, book reviews, and Letters to the Editor.
International Journal of Clinical Pharmacy is affiliated with the European Society of Clinical Pharmacy (ESCP). ESCP promotes practice and research in Clinical Pharmacy, especially in Europe. The general aim of the society is to advance education, practice and research in Clinical Pharmacy .
Until 2010 the journal was called Pharmacy World & Science.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
