In their study examining the feasibility of discontinuing medications in elderly patients, Garfinkel and Mangin1 were able to successfully stop nearly half of community-dwelling patients' medication therapies. Surprisingly, at follow-up 88% of patients reported overall improvement.
The authors propose an evidence-based, step-wise approach to evaluating medication regimens that has now proven effective in clinic and nursing home environments. We believe it would be interesting to extend this tool to the hospital setting. Hospitalization presents an opportune point of intervention where long-term medication management decisions could be addressed as part of the comprehensive review of medications and their indications inherent in the medication reconciliation process. Up to 1 in 5 patients discharged from the hospital have an adverse event, the majority of which are related to medications.2 The likelihood of medication discrepancies and adverse drug events is closely related to the total number of medications a patient is taking.3,4 In addition, hospitalization has the potential to provide time for patient education about medications and discussion of how high-risk medications affect a patient's goals of care. Hospital discharge offers a natural break point for the application of this type of tool to reduce rather than expand a patient's medication list.
Borne R, Cumbler E, Glasheen JJ. Reducing Polypharmacy: Is Hospitalization the Right Time?. Arch Intern Med. 2011;171(9):869-870. doi:10.1001/archinternmed.2011.208