Evaluation of pharmacist-led physician-supported inpatient deprescribing model in older patients admitted to an acute general medical unit.

OBJECTIVE: To evaluate the need for and the feasibility of a pharmacist-led physician-supported deprescribing model. METHODS: All patients aged ≥65 years, with polypharmacy, admitted to the acute general medical unit (GMU) of an Australian tertiary hospital over a 6-week period were prospectively evaluated for deprescribing by team pharmacists. Clinical decision-making was supported by physicians. RESULTS: One hundred and twenty-nine patients met inclusion criteria, and 58 (45%) were identified for deprescribing. Ninety-two (7.2%) deprescribing instances were identified of 1277 medications prescribed. Of these, 46 (50%) were successfully deprescribed during inpatient admission in 35 (60%) patients. The most prevalent rationale for deprescribing was "harm outweighing benefits." Outpatient deprescribing was planned in 16 (17%) of instances, and 39 (42%) would require outpatient follow-up to ensure adherence to recommendations and safety. No predictors for deprescribing were identified on univariate analyses. CONCLUSIONS: A pharmacist-led physician-supported deprescribing model is feasible in GMU patients who have polypharmacy.

Hypertension, antihypertensive treatment and cancer incidence and mortality: a pooled collaborative analysis of 12 Australian and New Zealand cohorts.

BACKGROUND: Observational studies examining associations between hypertension and cancer are inconsistent. We explored the association of hypertension, graded hypertension and antihypertensive treatment with cancer incidence and mortality. METHOD: Eighty-six thousand five hundred and ninety-three participants from the Australian and New Zealand Diabetes and Cancer Collaboration were linked to the National Death Index and Australian Cancer Database. Cox proportional hazards models estimated hazard ratios and 95% confidence intervals (95% CI) for the association of treated and untreated hypertension with cancer incidence and mortality. RESULTS: Over a median follow-up of 15.1 years, 12 070 incident and 4350 fatal cancers were identified. Untreated and treated hypertension, compared with normotension, were associated with an increased risk for cancer incidence [hazard ratio 1.06, 95% CI (1.00-1.11) and 1.09 (1.02-1.16) respectively], and cancer mortality (1.07, 0.98-1.18) and (1.15, 1.03-1.28), respectively. When compared with untreated hypertension, treated hypertension did not have a significantly greater risk for cancer incidence (1.03, 0.97-1.10) or mortality (1.07, 0.97-1.19). A significant dose-response relationship was observed between graded hypertension and cancer incidence and mortality; Ptrend = 0.053 and Ptrend = 0.001, respectively. When stratified by treatment status, these relationships remained significant in untreated, but not in treated, hypertension. CONCLUSION: Hypertension, both treated and untreated, is associated with a modest increased risk for cancer incidence and mortality. Similar risks in treated and untreated hypertension suggest that the increased cancer risk is not explained by the use of antihypertensive treatment.