Contributions of pharmaceutical interventions to the multidisciplinary dysphagia team: A retrospective observational study

TL;DR

This study shows that pharmacists can help reduce medication risks for patients with swallowing difficulties, especially those taking dopamine-blocking drugs.

Contribution

The study validates the clinical impact of pharmaceutical interventions in managing drug-induced dysphagia and reducing medication burden.

Findings

Pharmaceutical interventions reduced medication burden by an average of 3.2 medications (P < 0.001).

Dopamine antagonists were the most common drugs linked to drug-induced dysphagia.

Patients with dementia were most likely to experience suspected drug-induced dysphagia.

Abstract

The 2022 revision of Japanese healthcare reimbursement removed pharmacists from the mandatory dysphagia team, despite emerging evidence of medication-related swallowing complications. Our previous pharmacovigilance analysis identified dopamine-blocking drugs as primary contributors to the risk of aspiration pneumonia. This study aimed to validate these findings through a clinical examination of pharmaceutical interventions performed by a multidisciplinary dysphagia team.

This retrospective observational study was conducted at a 97-bed community hospital in Osaka, Japan, from June 2023 to January 2024. All adult patients with suspected dysphagia who underwent a multidisciplinary team intervention were included in our analysis. Pharmaceutical intervention was requested when medication-related dysphagia or swallowing difficulties were suspected, with interventions classified into the following four categories: drug-induced dysphagia management, dosage form optimization, swallowing aid utilization, and medication burden reduction. Changes in the medication burden were analyzed using paired t-tests.

Among 59 patients with dysphagia (mean age, 81.1 ± 9.8 years; 33 males [55.9%], 26 females [44.1%]), 13 (22.0%) underwent pharmaceutical interventions. Drug-induced dysphagia management was the most common intervention (69.2%), targeting dopamine antagonists (sulpiride, risperidone, tiapride, and domperidone), benzodiazepines, and anticholinergics without dopamine-blocking effects. Suspected drug-induced dysphagia was the most common symptom among patients with dementia (38.9%). The intervention group showed a significant reduction in medication (mean, -3.2 medications; P < 0.001), whereas the non-intervention group showed no change. Among the non-intervention group, potential opportunities for the optimization of angiotensin-converting enzyme inhibitors were identified in antihypertensive therapy.

Pharmaceutical interventions may offer clinically meaningful contributions when utilized for patients with dysphagia, supporting the relevance of pharmacovigilance regarding the risks of dopamine antagonists. The findings of this study suggest the importance of reinstating pharmaceutical expertise to multidisciplinary dysphagia teams, as pharmacists provide clinically significant medication optimization, including identifying additional optimization opportunities through systematic medication reviews among vulnerable populations.

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