The article "Reducing Inappropriate Polypharmacy: The Process of Deprescribing" by Scott et al. (2015) addresses the significant burden of adverse drug events (ADEs) and health issues in older adults due to inappropriate polypharmacy. The authors propose a five-step deprescribing protocol to minimize polypharmacy and improve patient outcomes. Key points include: 1. **Definition of Deprescribing**: Deprescribing is the process of discontinuing medicines when their benefits outweigh their harms, considering individual patient goals, functioning, and preferences. 2. **Evidence of Efficacy**: Observational and randomized trials show that deprescribing can be safe and beneficial, reducing ADEs and improving patient outcomes. 3. **Protocol for Deprescribing**: - Ascertain all medicines and reasons for each. - Assess overall risk of drug-induced harm. - Evaluate each medicine's benefit versus harm. - Prioritize medicines for cessation based on benefit-harm ratio. - Implement a discontinuation regimen and monitor closely. 4. **Barriers and Enablers**: Barriers include clinical complexity, limited consultation time, and community attitudes. Enablers include collaborative prescriber-pharmacist reviews, patient education, and practical guidance. 5. **Strategies for Implementation**: Strategies at the individual and system levels include empowering patients, using validated criteria for deprescribing, and integrating deprescribing into clinical practice and guidelines. 6. **Future Research**: Areas requiring more research include the impact of deprescribing on adherence, costs, and long-term outcomes, as well as the most effective approaches for routine clinical settings. The article emphasizes the need for a systematic approach to deprescribing, supported by pharmacists and other healthcare professionals, to reduce unnecessary suffering and disability in older patients.The article "Reducing Inappropriate Polypharmacy: The Process of Deprescribing" by Scott et al. (2015) addresses the significant burden of adverse drug events (ADEs) and health issues in older adults due to inappropriate polypharmacy. The authors propose a five-step deprescribing protocol to minimize polypharmacy and improve patient outcomes. Key points include: 1. **Definition of Deprescribing**: Deprescribing is the process of discontinuing medicines when their benefits outweigh their harms, considering individual patient goals, functioning, and preferences. 2. **Evidence of Efficacy**: Observational and randomized trials show that deprescribing can be safe and beneficial, reducing ADEs and improving patient outcomes. 3. **Protocol for Deprescribing**: - Ascertain all medicines and reasons for each. - Assess overall risk of drug-induced harm. - Evaluate each medicine's benefit versus harm. - Prioritize medicines for cessation based on benefit-harm ratio. - Implement a discontinuation regimen and monitor closely. 4. **Barriers and Enablers**: Barriers include clinical complexity, limited consultation time, and community attitudes. Enablers include collaborative prescriber-pharmacist reviews, patient education, and practical guidance. 5. **Strategies for Implementation**: Strategies at the individual and system levels include empowering patients, using validated criteria for deprescribing, and integrating deprescribing into clinical practice and guidelines. 6. **Future Research**: Areas requiring more research include the impact of deprescribing on adherence, costs, and long-term outcomes, as well as the most effective approaches for routine clinical settings. The article emphasizes the need for a systematic approach to deprescribing, supported by pharmacists and other healthcare professionals, to reduce unnecessary suffering and disability in older patients.