Background

Many older adults are prescribed opioids and benzodiazepines (BZDs), despite increased susceptibility to adverse events. Challenges of deprescribing include fragmented care and lack of knowledge or time. Pharmacists are well-positioned to overcome these challenges and facilitate deprescribing of these medications.

Objectives

We sought to evaluate interventions utilizing pharmacists to deprescribe opioids and BZDs in older adults.

Methods

We conducted a rapid review following a comprehensive literature search to identify interventions with pharmacist involvement for deprescribing opioids and BZDs in older adults. Studies were included based on: (1) inclusion of patients ≥ 65 years old receiving BZDs and/or opioids, (2) evaluation of feasibility or outcomes following deprescribing (3) pharmacists as part of the intervention. We included randomized, observational, cohort, and pilot studies. Studies that did not report specific results for BZD or opioids were excluded.

Results

We screened 687 abstracts and included 17 studies. Most (n = 13) focused on BZD deprescribing. Few studies focused on opioids (n = 2) or co-prescribing of opioids and BZDs (n = 2). The most common intervention was educational brochures (n = 8), majority being the EMPOWER brochure for deprescribing BZDs. Other interventions included chart review with electronic notes (n = 4), pharmacist-led programs/services (n = 2), and multifactorial interventions (n = 3). Many studies were underpowered or lacked suitable control groups. Generally speaking, interventions utilizing educational materials and those in which pharmacists engaged with patients and providers were more effective. Interventions relying on electronic communication by pharmacists were less successful, due to low acceptance or acknowledgement.

Conclusions

We identified a number of feasible interventions to reduce BZD use, but fewer interventions to reduce opioid use in older adults. An optimal approach for deprescribing likely requires pharmacists to engage directly with patients and providers. Larger well-designed studies are needed to evaluate the effectiveness of deprescribing interventions beyond feasibility.

中文翻译：

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药剂师对老年人停用阿片类药物和苯二氮卓类药物的干预措施：快速回顾

 背景

尽管不良事件的易感性增加，但许多老年人仍服用阿片类药物和苯二氮卓类药物 (BZD)。取消处方的挑战包括护理分散以及缺乏知识或时间。药剂师有能力克服这些挑战并促进取消这些药物的处方。

 目标

我们试图评估利用药剂师为老年人停用阿片类药物和 BZD 的干预措施。

 方法

我们在进行全面的文献检索后进行了快速回顾，以确定药剂师参与的干预措施，以减少老年人服用阿片类药物和苯二氮卓类药物的处方。纳入研究的依据是：(1) 纳入≥ 65 岁接受 BZD 和/或阿片类药物的患者，(2) 评估作为干预措施一部分的药剂师取消处方后的可行性或结果。我们纳入了随机、观察、队列和试点研究。未报告 BZD 或阿片类药物具体结果的研究被排除在外。

 结果

我们筛选了 687 篇摘要并纳入 17 项研究。大多数（n = 13）关注的是 BZD 的停用。很少有研究关注阿片类药物 (n = 2) 或阿片类药物与 BZD 的联合处方 (n = 2)。最常见的干预措施是教育手册（n = 8），其中大多数是用于取消 BZD 处方的 EMPOWER 手册。其他干预措施包括电子笔记图表审查 (n = 4)、药剂师主导的计划/服务 (n = 2) 和多因素干预措施 (n = 3)。许多研究动力不足或缺乏合适的对照组。一般来说，利用教育材料的干预措施以及药剂师与患者和提供者接触的干预措施更为有效。由于接受度或认可度较低，药剂师依赖电子通信的干预措施不太成功。

 结论

我们确定了一些减少 BZD 使用的可行干预措施，但减少老年人阿片类药物使用的干预措施较少。取消处方的最佳方法可能需要药剂师直接与患者和提供者接触。需要更大规模、精心设计的研究来评估超出可行性的取消处方干预措施的有效性。