Abstract
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For patients and families whose main goals are symptom relief and maximizing quality of life, deprescribing allows for the reduction of unnecessary or inappropriate medications. Online tools are available to aid in this decision-making process and help streamline medication regimens, especially in settings wherein the provider has little access to pharmacy support. We review two existing websites that support deprescribing. Each website was accessed in October 2017.
MedStopper is an online interactive tool available to assist clinicians with decisions about reducing or stopping medications. A patient's medication list is entered by the user and MedStopper will organize the medications according to their priority for discontinuation based on three criteria: (1) the potential for the medication to improve symptoms, (2) the potential for the medication to reduce the risk of future illness, and (3) the potential for the medication to cause harm. Specific strategies for how to taper the medication are also available.
Pros:
• Provides specific deprescribing instructions. • Ranks deprescribing priority (among total medication list). • Factors in patients' frailty in determining potential harm of medications. • Provides possible symptoms when stopping or tapering. • Provides a link to the Beers/STOPP criteria that allows the user to view the specific recommendation. • Has a print option so that the plan/instructions can easily be printed for use with patients.
Cons:
• Does not address life expectancy, comorbid conditions, or limited renal/hepatic function. • Not all medications have specific taper recommendations, for example, “tapering suggestions should be discussed with a specialist” (e.g., diltiazem).
How clinicians can use this tool:
• Go to “www.medstopper.com.” • Indicate whether patient is frail elderly or not. • Search medications by brand/generic name and follow prompts to add to medication list (indicate “condition treated” through the drop down). • Once all medications are added, review the provided information.
Deprescribing.org is an online reference tool that features evidence-based guidelines and algorithms as part of a project that was funded by the Government of Ontario in Canada to support clinicians in safely reducing or stopping medications for specific drug classes—for example, proton pump inhibitors (PPIs), benzodiazepines, and antipsychotics. The website also has links to YouTube “whiteboard” videos that highlight how to use the algorithm using patient cases. The goals of this website are also to share information about ongoing deprescribing initiatives and research and to link individuals who are interested in deprescribing to each other and to pertinent resources.
Pros:
• Promotes deprescribing to mitigate polypharmacy. • Provides specific deprescribing instructions. • Provides nonpharmacological strategies including cognitive behavioral therapy to use in conjunction with tapering. • Use of video as learning tool.
Cons:
• Limited to antipsychotics, PPIs, benzodiazepines, and antihyperglycemic agents. • The priority for deprescribing is not ranked, which may make it difficult for clinicians to determine what to deprescribe first in patients on more than one of these agents. • Does not address age, frailty, life expectancy, comorbid conditions, or limited renal/hepatic function. • Steps to obtain and download algorithms may not be intuitive.
How this is useful to clinicians:
• Go to www.deprescribing.org—Optimizing Medication Use. • Click on “Learn about the algorithms.” • Select the medication deprescribing guideline or algorithm of interest. The algorithm will pop up in this new window. This may be saved or printed for future reference. One can also select the link that will open up a YouTube video, also in a new browser window.
Conclusion
The reduction of medication burden in patients at the end of life is an important part of patient-centered care. Deprescribing allows for the identification and elimination of unnecessary or inappropriate medications. This, in turn, will decrease the rates of medication side effects and drug–drug or drug–disease interactions. In a recent study, patients with an estimated prognosis of 12 months or less had an average of 10.5 medications at the time of death or at the end of study. 1 Resources such as Medstopper.com and Deprescribing.org may help to promote less complicated regimens, alleviate medications with harmful side effects, and stop medications that are no longer providing benefit.