Evidence map›Paper›PMID 37160561›Full record

ArticleDrugs & aging2023

Impact of a Comprehensive Intervention Bundle Including the Drug Burden Index on Deprescribing Anticholinergic and Sedative Drugs in Older Acute Inpatients: A Non-randomised Controlled Before-and-After Pilot Study.

Kenji Fujita, Patrick Hooper, Nashwa Masnoon, Sarita Lo, Danijela Gnjidic, Christopher Etherton-Beer, Emily Reeve, Parker Magin, J Simon Bell, Kenneth Rockwood and 4 more

Open access · hybridAbstract readControlled Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Article in Drugs & aging, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
3.0field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 17 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 7 institutions in 2 countries.

Kenji FujitaDepartments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia.ORCID 0000-0001-7876-6004
Patrick HoopereMR Connect Program, eHealth NSW, Sydney, NSW, Australia.ORCID 0000-0002-1796-3183
Nashwa MasnoonDepartments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia.ORCID 0000-0002-7123-9583
Sarita LoDepartments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia.ORCID 0000-0002-5272-9958
Danijela GnjidicSchool of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID 0000-0002-9404-3401
Christopher Etherton-BeerWA Centre for Health and Ageing, The University of Western Australia, Crawley, WA, Australia.ORCID 0000-0001-5148-0188
Emily ReeveCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.ORCID 0000-0002-1405-999X
Parker MaginSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.
J Simon BellCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.
Kenneth RockwoodDepartment of Medicine (Geriatric Medicine & Neurology), Dalhousie University; Frailty and Elder Care Network, Nova Scotia Health, Halifax, Nova Scotia, Canada.ORCID 0000-0002-6674-995X
Lisa Kouladjian O'DonnellDepartments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia.ORCID 0000-0003-0927-7295
Mouna SawanSchool of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID 0000-0002-0565-3524
Melissa BaysariBiomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.ORCID 0000-0003-1645-9126
Sarah N HilmerDepartments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. sarah.hilmer@sydney.edu.au.ORCID 0000-0002-5970-1501
The University of Sydney · AUDalhousie University · CAMonash University · AUNew South Wales Department of Health · AUThe University of Western Australia · AUUniversity of Newcastle Australia · AUUniversity of South Australia · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionImplementation of the Drug Burden Index (DBI) as a risk assessment tool in clinical practice may facilitate deprescribing.

objectiveThe purpose of this study is to evaluate how a comprehensive intervention bundle using the DBI impacts (i) the proportion of older inpatients with at least one DBI-contributing medication stopped or dose reduced on discharge, compared with admission; and (ii) the changes in deprescribing of different DBI-contributing medication classes during hospitalisation.

methodsThis before-and-after study was conducted in an Australian metropolitan tertiary referral hospital. Patients aged ≥ 75 years admitted to the acute aged care service for ≥ 48 h from December 2020 to October 2021 and prescribed DBI-contributing medication were included. During the control period, usual care was provided. During the intervention, access to the intervention bundle was added, including a clinician interface displaying DBI score in the electronic medical record. In a subsequent 'stewardship' period, a stewardship pharmacist used the bundle to provide clinicians with patient-specific recommendations on deprescribing of DBI-contributing medications.

resultsOverall, 457 hospitalisations were included. The proportion of patients with at least one DBI-contributing medication stopped/reduced on discharge increased from 29.9% (control period) to 37.5% [intervention; adjusted risk difference (aRD) 6.5%, 95% confidence intervals (CI) -3.2 to 17.5%] and 43.1% (stewardship; aRD 12.1%, 95% CI 1.0-24.0%). The proportion of opioid prescriptions stopped/reduced rose from 17.9% during control to 45.7% during stewardship (p = 0.04).

conclusionIntegrating a comprehensive intervention bundle and accompanying stewardship program is a promising strategy to facilitate deprescribing of sedative and anticholinergic medications in older inpatients.

Indexed as

DeprescriptionsAgedAustraliaCholinergic AntagonistsHumansHypnotics and SedativesInpatientsPilot ProjectsCholinergic AntagonistsHypnotics and Sedatives

Identifiers

PMID37160561
PMCPMC10299923
OpenAlexW4376121868

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.