Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review: the LeMON study (Less Medicines in Older Patients in the Netherlands), a cluster randomized controlled trial

Background Deprescribing of inappropriate cardiovascular and diabetes medication has shown to be adequate, feasible and safe. Healthcare providers often experience the deprescribing of cardiovascular and diabetes medication as a challenge and therefore it is still not widely implemented in daily practice. Aim The aim was to assess whether a training on the performance of a more deprescribing-focused clinical medication review results in a greater reduction of inappropriate use of cardiovascular and diabetes medication. Method A cluster randomized controlled trial involving 20 community pharmacists, who conducted a clinical medication review in 10 patients. The intervention group received a training on deprescribing. Patients 70 years or older; polypharmacy and use of antihypertensive medication and having a systolic blood pressure below 140 mmHg, and/or use of diabetes medication and HbA1c level below 54 mmol/mol were included. Follow-up took place within four weeks (T1) and after three months (T2). Results 71 and 69 patients were included in the intervention and control group, respectively. At T2 32% and 26% of the patients in the intervention and control group had the use of one or more cardiovascular or diabetes medication discontinued. With regard to any medication these percentages were 51% and 36%, respectively. Conclusion Increased awareness and ability of community pharmacists to deprescribe medication and use of general practitioners data, led community pharmacists and general practitioners to successfully conduct a more deprescribing-focused clinical medication review in daily practice. Further research on the need for additional training to optimize deprescribing cardiovascular and diabetes medication is required.