The Lancet Diabetes & Endocrinology, Journal Year: 2025, Volume and Issue: unknown
Published: Feb. 1, 2025
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
The Journals of Gerontology Series A, Journal Year: 2021, Volume and Issue: 77(5), P. 1020 - 1034
Published: Aug. 14, 2021
Abstract Background Harmful and/or unnecessary medication use in older adults is common. This indicates deprescribing (supervised withdrawal of inappropriate medicines) not happening as often it should. study aimed to synthesize the results Patients’ Attitudes Towards Deprescribing (PATD) questionnaire (and revised versions). Methods Databases were searched from January 2013 March 2020. Google Scholar was used for citation searching development and validation manuscripts identify original research using validated PATD, PATD (older adult caregiver versions), version people with cognitive impairment (rPATDcog). Two authors extracted data independently. A meta-analysis proportions (random-effects model) conducted subgroup meta-analyses setting population. The primary outcome question: “If my doctor said possible, I would be willing stop one or more medicines.” Secondary outcomes associations between participant characteristics other (r)PATD results. Results We included 46 articles describing 40 studies (n = 10,816 participants). found proportion participants who agreed strongly this statement 84% (95% CI 81%–88%) 80% 74%–86%) patients caregivers, respectively, significant heterogeneity (I2 95% 77%). Conclusion Consumers reported willingness have a deprescribed although should interpreted caution due heterogeneity. findings moves toward understanding attitudes deprescribing, which could increase discussion uptake recommendations clinical practice.
Language: Английский
Citations
78
Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 71(6), P. 1701 - 1713
Published: April 20, 2023
Abstract Whether initiation of statins could increase survival free dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double‐blind, placebo‐controlled randomized pragmatic clinical trial, will compare high‐intensity statin therapy (atorvastatin 40 mg) with placebo 20,000 community‐dwelling without cardiovascular disease, disability, or at baseline. Exclusion criteria include use the prior year for >5 inability to take statin. Potential participants are identified using computable phenotypes derived from electronic health record local referrals community. Participants undergo baseline cognitive testing, physical testing blinded lipid panel if feasible. Cognitive screening be conducted annually. Multiple data sources queried events, dementia, disability; site‐reported supplemented by National Death Index search. The primary outcome new persisting disability. Co‐secondary outcomes composite death, hospitalization unstable angina myocardial infarction, heart failure, stroke, coronary revascularization; mild impairment dementia. Ancillary studies offer mechanistic insights into effects on key outcomes. Biorepository samples obtained stored future study. These results inform benefit increasing among older adults. This pioneering study important questions low participant burden align needs growing population
Language: Английский
Citations
35
JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(2), P. e2457498 - e2457498
Published: Feb. 10, 2025
Importance Better understanding of patients’ attitudes toward deprescribing specific medications will inform future interventions. Objective To investigate older adults’ by investigating which they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing. Design, Setting, Participants This survey study was conducted from May 2022 December 2023 primary care settings 14 countries. Patients aged 65 years or taking 5 more were consecutively recruited their general practitioner (GP) completed questionnaire. Exposures Patient characteristics, including gender, number medications, GP education level, financial status, confidence completing medical forms, self-rated health, satisfaction trust GP, country. Main Outcomes Measures The outcomes as measured responses question, “Thinking about your current medication list, are there any that you stop reduce dose of?” Multilevel multivariable logistic regression analysis used, adjusted for clustering effect at country association between characteristics Results Of 1340 patients (mean [SD], 96 [47] per country), 736 (55%) women, 580 (44%) had secondary school highest level education, 1089 (82%) satisfied 589 expressed deprescribe 1 medications. varying levels, 79% (86 109 patients) Poland 23% (21 Bulgaria. 3 most reported deprescribed diuretics (111 1002 [11%]), lipid-modifying agents (109 acting on renin-angiotensin system (83 [8%]). odds naming least lower higher (odds ratio, 0.31; 95% CI, 0.21-0.47) 0.960; 0.930-0.998). Conclusions Relevance In this older, varied across countries, demonstrating interventions could be impactful when adapted contexts. These findings highlight importance patient-practitioner communication ensuring appropriate use.
Language: Английский
Citations
1
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
Research in Social and Administrative Pharmacy, Journal Year: 2018, Volume and Issue: 15(6), P. 801 - 805
Published: Sept. 18, 2018
Language: Английский
Citations
70
British Journal of Clinical Pharmacology, Journal Year: 2019, Volume and Issue: 85(7), P. 1396 - 1406
Published: March 8, 2019
Aims To identify and evaluate content readability of freely available online deprescribing patient education materials (PEMs). Methods Systematic review PEMs using MEDLINE, Embase, CINAHL, PsycINFO The Cochrane Library Reviews from inception to 25 September 2017 PEMs. Additionally, researchers health professionals were surveyed additional materials. Known repositories searched followed by a systematic Google search (22–28 January 2018). Materials evaluated an approach informed the Patient Education Material Assessment Tool International Decision Aids Standards Inventory. Readability text‐based was assessed US‐based Gunning–Fog Index Flesch–Kincaid Grade level. Results Forty‐eight identified. addressing medications for symptom control (81%) most common. Preventative rarely addressed material (39%) focused on older people. Only 37% provided information about both potential benefits (e.g. reducing risk side effects) harms withdrawal symptoms, increased disease) deprescribing, while 40% focussed only. indices indicated average minimum reading level 12. Option Grids (mean below 10) suitable people with literacy levels. Conclusions Over 1/3 present indicating are not balanced. Most pitched above levels making them inaccessible low populations.
Language: Английский
Citations
64
European Geriatric Medicine, Journal Year: 2021, Volume and Issue: 12(3), P. 499 - 507
Published: Feb. 13, 2021
Language: Английский
Citations
45
Health Technology Assessment, Journal Year: 2022, Volume and Issue: 26(32), P. 1 - 148
Published: July 1, 2022
Tackling problematic polypharmacy requires tailoring the use of medicines to individual needs and circumstances. This may involve stopping (deprescribing) but patients clinicians report uncertainty on how best do this. The TAILOR medication synthesis sought help understand support deprescribing in older people living with multimorbidity polypharmacy.
Language: Английский
Citations
33