A pilot study of a Medication Rationalization (MERA) intervention

CMAJ Open
Rachel WhittyJames Downar

Abstract

Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications. We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity. The MERA team reviewed the patients' medications and made recommendations on the basis of guidelines. We measured end points for feasibility, acceptability, efficiency and effectiveness. We enrolled 61 of 115 (53%) eligible patients with a mean age of 79.6 years (standard deviation [SD] 11.7 yr). Patients were taking an average of 11.5 (SD 5.2) medications before admission and had an average of 2.1 symptoms with greater than 6/10 severity on the revised Edmonton Symptom Assessment System. The MERA team recommended 263 medication changes, of which 223 (85%) were accepted by both the medical team and the patient. MERA team's recommendations resulted in the discontinuation of 162 medications (mean 3.1 per patient), dose changes for 48 medications (mean 0.9 per patient) and the add...Continue Reading

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Citations

Jun 30, 2019·Journal of the American Geriatrics Society·Emily G McDonaldTodd C Lee
Dec 17, 2020·Journal of Palliative Medicine·Yifan LiAmna F Husain
Aug 15, 2021·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·Kristie Rebecca WeirEmily Reeve

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