Research in Social and Administrative Pharmacy, Journal Year: 2018, Volume and Issue: 15(6), P. 682 - 690
Published: Aug. 22, 2018
Language: Английский
BJGP Open, Journal Year: 2020, Volume and Issue: 4(3), P. bjgpopen20X101096 - bjgpopen20X101096
Published: July 28, 2020
Background Managing polypharmacy is a challenge for healthcare systems globally. It also health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care patients with multimorbidity occurs primary care. Safe deprescribing interventions reduce exposure inappropriate polypharmacy. However, these are not fully accepted or routinely implemented. Aim To identify barriers facilitators safe adults Design & setting A systematic review studies published from 2000, examining Method search electronic databases: MEDLINE, Embase, Cumulative Index Nursing Allied Health Literature (CINHAL), Cochrane, Management Information Consortium (HMIC) inception 26 Feb 2019, using an agreed strategy. This was supplemented by handsearching relevant journals, screening reference lists citations included studies. Results In total, 40 14 countries were identified. Cultural organisational included: culture diagnosing prescribing; evidence-based guidance focused on single diseases; lack care older people multimorbidities; shared communication, decision-making systems, tools, resources. Interpersonal individual-level professional etiquette; fragmented care; prescribers’ patients’ uncertainties; gaps tailored support. Facilitators prudent greater availability acceptability non-pharmacological alternatives; resources; improved collaboration, knowledge, understanding; patient-centred decision-making. Conclusion whole approach required, involving key decision-makers, professionals, patients, carers.
Language: Английский
Citations
157
Innovation in Aging, Journal Year: 2025, Volume and Issue: 9(2)
Published: Jan. 1, 2025
Polypharmacy, the concurrent use of multiple medicines, is a growing concern among older adults and those with chronic conditions. Deprescribing through dose reduction or discontinuing selected medicines strategy for reducing medicine-related harm. The Patient Typology was developed using qualitative methods to describe varying factors that are important when they consider deprescribing. objective this study quantitative define distinct classes via Typology. This used cross-sectional experimental design in which data collected an online survey from participants 65 years Australia, Netherlands, United Kingdom, States. A latent class analysis performed 4-item about beliefs importance how learn medicine decision-making preferences, attitudes towards stopping medicines. Older (n = 2,250) were median 70 2-thirds reported their highest level education associate's degree trade school less. We identified 4 classes: Class 1 "Trusts doctor" (41.6%), 2 "Makes own decisions" (30.2%), 3 "Avoids deprescribing" (15.5%), 'Medicines not important' (12.7%). report diverse perspectives deprescribing, emphasizing need tailored communication strategies clinical settings. Additional research needed examine adults' preferences real-world contexts refine improve deprescribing interventions. NCT04676282.
Language: Английский
Citations
2
Journal of Pharmacy Practice and Research, Journal Year: 2020, Volume and Issue: 50(1), P. 98 - 107
Published: Feb. 1, 2020
Abstract The importance of deprescribing, which is the process withdrawing an inappropriate medication, supervised by a healthcare professional with goal managing polypharmacy and improving outcomes, increasingly recognised as part good clinical care. With this, number tools have been developed purpose aiding health professionals to deprescribe in regular practice. types vary significantly their form include aid overall deprescribing (such generic frameworks drug‐specific guidelines) well that may assist specific identifying medications or engaging patient). While many are available, most provide little (if any) information on how they were developed, limited implementation research has conducted. This paper provides overview available might be used
Language: Английский
Citations
88
Expert Review of Clinical Pharmacology, Journal Year: 2020, Volume and Issue: 13(3), P. 233 - 245
Published: Feb. 14, 2020
Introduction: There is increasing recognition of the need for deprescribing inappropriate medications in older adults. However, efforts to encourage implementation clinical practice have resulted mixed results across settings and countries.Area covered: Searches were conducted PubMed, Embase, Google Scholar June 2019. Reference lists, citation checking, personal reference libraries also utilized. Studies capturing main challenges of, opportunities for, implementing into selected health-care internationally, international deprescribing-orientated policies included summarized this narrative review.Expert opinion: Deprescribing intervention studies are inherently heterogeneous because complexity interventions employed often do not reflect real-world. Further research investigating enhanced required. Process evaluations needed determine contextual factors that important translation may be individually tailored target unique barriers different settings. Introduction national beneficial, but evaluated if there any unintended consequences.
Language: Английский
Citations
82
Medical Science Educator, Journal Year: 2023, Volume and Issue: 33(2), P. 551 - 567
Published: Feb. 23, 2023
Deprescribing involves reducing or stopping medications that are causing more harm than good no longer needed. It is an important approach to managing polypharmacy, yet healthcare professionals identify many barriers. We present a proposed pre-licensure competency framework describes essential knowledge, teaching strategies, and assessment protocols promote interprofessional deprescribing skills. The considers how involve patients care partners in decisions. An action plan example curriculum mapping exercise included help educators assess their curricula, select implement these concepts strategies within programs ensure learners graduate with competencies manage increasingly complex medication regimens as people age.The online version contains supplementary material available at 10.1007/s40670-022-01704-9.
Language: Английский
Citations
25
Health Science Reports, Journal Year: 2018, Volume and Issue: 1(7)
Published: May 10, 2018
Abstract Aims This review investigates the factors that influence deprescribing of medications in primary care from perspective general practitioners (GPs) and community‐living older adults. Methods A mixed studies structure was adopted searching Scopus, CINAHL, PsychINFO, ProQuest, PubMed January 2000 to December 2017. manual search reference lists also conducted. Studies were included if they original research available English explored rather than a specific class medications. The Mixed Assessment Tool used assess quality studies, content analysis generated common categories across studies. Results Thirty‐eight articles included, 7 key identified. found are similar within health systems mostly act as barriers. These remained unchanged period. structural organisation remains poorly suited facilitate deprescribing. Individual knowledge gaps both GPs adults practices attitudes towards deprescribing, significant communication occur between specialists As result, decision making is characterised by uncertainty, often considered only when medication problems have already arisen. Trust plays complex role, acting barrier facilitator Conclusions Deprescribing influenced many factors. Despite recent interest, little change has occurred. Multilevel strategies aimed at reforming aspects system managing uncertainty practice individual level, notably reducing limitations closing communications gaps, may achieve change.
Language: Английский
Citations
73
BMJ Open, Journal Year: 2022, Volume and Issue: 12(3), P. e054279 - e054279
Published: March 1, 2022
Objective To explore the barriers/facilitators to deprescribing in primary care England from perspectives of clinicians, patients living with frailty who reside at home, and their informal carers, drawing on Theoretical Domains Framework identify behavioural components associated process. Design Exploratory qualitative study. Setting General practice (primary care) England. Participants 9 aged 65+ attended a consultation reduce or stop medicine/s. 3 carers frailty. 14 clinicians including general practitioners, pharmacists advanced nurse practitioners. Methods Qualitative semistructured interviews took place frailty, clinicians. Patients (n=9) (n=3) were interviewed two times: immediately after 5/6 weeks later. Clinicians (n=14) once. In total, 38 undertaken. analysis was applied manage analyse data. Results 6 themes facilitators barriers generated, respectively, each supported by between three subthemes. Identified included shared decision-making, gradual introduction topic, clear communication topic patient multidisciplinary working. constraints, patients' fear negative consequences inaccessible terminology information. Conclusions This paper offers timely insight into for within context As continues grow national international significance, it is important that future interventions acknowledge current experienced improve safety effectiveness
Language: Английский
Citations
30
International Journal of Clinical Pharmacy, Journal Year: 2019, Volume and Issue: 41(3), P. 793 - 803
Published: April 24, 2019
Language: Английский
Citations
53
BMJ Open, Journal Year: 2020, Volume and Issue: 10(6), P. e035087 - e035087
Published: June 1, 2020
Objective Limited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop assess feasibility an intervention involving pharmacists, working within practices, optimise prescribing in Ireland. Design Non-randomised pilot study. Setting Primary care Participants Four purposively sampled recruited reflect a range sizes demographic profiles. Intervention A pharmacist joined 6 months (10 hours/week) undertook medication reviews (face face or chart based) adult provided advice, supported clinical audits facilitated practice-based education. Outcome measures Anonymised practice-level (eg, changes) cost data were collected. Patient-reported outcome measure (PROM) collected on subset older adults (aged ≥65 years) polypharmacy using patient questionnaires, before weeks after review by pharmacist. Results Across four 786 patients identified as having 1521 issues pharmacists. Issues relating deprescribing medications addressed most often prescriber (59.8%), compared cost-related (5.8%). Medication changes made during equated approximately €57 000 savings assuming they persisted 12 months. Ninety-six aged years from practices PROM collection 64 (66.7%) followed up. There no patients’ treatment burden attitudes following review, there conflicting self-reported quality life. Conclusions non-randomised demonstrated that is feasible implement has potential quality. provides rationale conduct randomised controlled trial evaluate cost-effectiveness this intervention.
Language: Английский
Citations
42
BMC Geriatrics, Journal Year: 2021, Volume and Issue: 21(1)
Published: June 16, 2021
Overtreatment with cardiometabolic medication in older patients can lead to major adverse events. Timely deprescribing of these medications is therefore essential. Self-reported willingness stop usually high among people, still overtreatment common and rarely initiated. An important barrier for reported by general practitioners the patients' unwillingness medication. More insights are needed into influence characteristics on their attitudes towards differences between groups.A survey people using revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was performed. Participants completed rPATD an adapted version four groups. Linear ordinal logistic regression were used assess age, sex, therapeutic area number deprescribing. Univariate analysis compare sulfonylureas, insulins, antihypertensive statins.Overall, 314 out 1143 invited participants (median age 76 years, 54% female). Most (80%) satisfied willing if doctor said it possible (88%). Age, sex had no Taking more than ten medicines significantly associated a higher perceived burden. Antihypertensive insulin considered appropriate statins, sulfonylureas not favouring deprescribing.The majority one possible. Health care providers should take account that perceive some as other when discussing
Language: Английский
Citations
37