Demystifying Value-Based Care: Managing Costs of Care-Deprescribing Algorithm

Deprescribing Algorithm

Pdf Summary

The document provides comprehensive guidelines for employing a deprescribing algorithm, particularly for the elderly, focusing on physiological changes, inappropriate medication use, tools for medication de-escalation, and specific considerations for diverse medication categories.<br /><br />1. **Physiological Changes and Aging:** Points out the decrease in body water, muscle mass, and organ function, alongside an increase in body fat, affecting pharmacokinetics. Case-by-case evaluations are necessary due to the absence of specific biomarkers signaling pharmacokinetic changes with aging.<br /><br />2. **Inappropriate Medication Use:** Emphasizes monitoring for wrong dosages, medication interactions, duplications, and prescribing cascades. Recent hospitalizations or specialist visits can signal the need for reevaluation.<br /><br />3. **Tools for De-escalation:** Highlights the Beers Criteria, which provides evidence-based recommendations on drugs to avoid in the elderly. The criteria need to be filtered through clinical judgment and focus on commonly problematic drug classes.<br /><br />4. **Steps to De-escalate:** A five-step method involves:<br />   - Reconciling all medications and their need.<br />   - Reviewing risks and patient adherence.<br />   - Assessing each drug for necessity.<br />   - Prioritizing drugs for discontinuation.<br />   - Implementing and closely monitoring the discontinuation process.<br /><br />5. **Tapering Medications:** General guidelines recommend halving doses progressively, viewing the process as a trial, and discontinuing one medication at a time to monitor withdrawal effects accurately.<br /><br />6. **Considerations for Specific Medication Categories:**<br />   - **Benzodiazepines:** Gradual tapering to avoid withdrawal symptoms.<br />   - **Antihypertensives and Statins:** Evaluating the balance of risks and benefits; some cases do not require tapering.<br />   - **Warfarin:** Low doses for seniors, tapering based on the condition treated.<br />   - **NSAIDs:** Stopping if risks outweigh benefits, with potential tapering.<br />   - **Acid Suppressants:** Tapering recommended to prevent rebound acid secretion.<br /><br />The summary emphasizes the importance of systematic medication review, appropriate use of clinical tools like the Beers Criteria and STOPP, and careful management of the discontinuation process for elderly patients.

Keywords

deprescribing algorithm

elderly

physiological changes

inappropriate medication

medication de-escalation

Beers Criteria

tapering medications

medication categories

systematic review

clinical tools