Deprescribing in older adults with polypharmacy

BMJ, Journal Year: 2024, Volume and Issue: unknown, P. e074892 - e074892

Published: May 7, 2024

Abstract Polypharmacy is common in older adults and associated with adverse drug events, cognitive functional impairment, increased healthcare costs, risk of frailty, falls, hospitalizations, mortality. Many barriers exist to deprescribing, but efforts have been made develop implement deprescribing interventions that overcome them. This narrative review describes intervention components summarizes findings from published randomized controlled trials tested polypharmacy, as well reports on ongoing trials, guidelines, resources can be used facilitate deprescribing. Most were medication reviews primary care settings, many contained such shared decision making and/or a focus patient priorities, training for professionals, facing education materials, involvement family members, representing great heterogeneity addressing polypharmacy adults. Just over half study found perform better than usual at least one their outcomes, most assessed 12 months or less.

Language: Английский

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What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis

BMC Geriatrics, Journal Year: 2023, Volume and Issue: 23(1)

Published: Sept. 25, 2023

A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate (deprescribing). Recent recommendations for effective deprescribing include shared-decision making a multidisciplinary approach. Our aim was understand when, why, how interventions review involving teams (MDTs) work (or do not work) people.

Language: Английский

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Deprescribing for nursing home residents with limited life expectancy: A qualitative study to identify barriers and enablers for healthcare professionals

Geriatric Nursing, Journal Year: 2025, Volume and Issue: 62, P. 1 - 11

Published: Feb. 4, 2025

Language: Английский

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Clinical decision‐making in benzodiazepine deprescribing by healthcare providers vs. AI‐assisted approach

British Journal of Clinical Pharmacology, Journal Year: 2023, Volume and Issue: 90(3), P. 662 - 674

Published: Nov. 11, 2023

Abstract Aims The aim of this study was to compare the clinical decision‐making for benzodiazepine deprescribing between a healthcare provider (HCP) and an artificial intelligence (AI) chatbot GPT4 (ChatGPT‐4). Methods We analysed real‐world data from Croatian cohort community‐dwelling patients ( n = 154) within EuroAgeism H2020 ESR 7 project. HCPs evaluated using pre‐established criteria assess discontinuation potential. research team devised tested AI prompts ensure consistency with HCP judgements. An independent researcher employed ChatGPT‐4 predetermined simulate decisions each patient case. Data derived human‐HCP were compared agreement rates Cohen's kappa. Results Both HPC ChatGPT identified (96.1% 89.6%, respectively), showing rate 95% κ .200, P .012). Agreement on four ranged 74.7% 91.3% (lack indication .352, < .001; prolonged use .088, .280; safety concerns .123, .006; incorrect dosage .264, .001). Important limitations GPT‐4 responses identified, including 22.1% ambiguous outputs, generic answers inaccuracies, posing inappropriate risks. Conclusions While AI‐HCP is substantial, sole reliance poses risk unsuitable decision‐making. This study's findings reveal both strengths areas enhancement in recommendations sample. Our underscores need additional functionality therapy decision‐making, further fostering advancement optimal performance.

Language: Английский

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An Educational Intervention to Promote Central Nervous System-Active Deprescribing in Dementia: A Pilot Study

Drugs & Aging, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 20, 2025

Language: Английский

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Factors Influencing General Practitioners’ Deprescribing Decisions for Older Adults, with Insights into Frailty: a Qualitative Study in Greek Primary Care

Drugs & Aging, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 21, 2025

Language: Английский

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Assertiveness in community pharmacists and their experience of pharmacist-led deprescribing: A cross-sectional study

Research in Social and Administrative Pharmacy, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Deprescribing by physicians based on the suggestions of community pharmacists is useful to ensure medication safety. Pharmacist-led deprescribing not always implemented smoothly because communication gaps between and pharmacists. Our previous study found that assertiveness, as a style, associated with pharmacist-initiated prescription changes for safety; however, its association pharmacist-led unclear. objective was investigate which types self-expression related assertiveness are while adjusting possible confounding factors. We conducted cross-sectional survey among May October 2022. Participants were belonging nationwide pharmacy chain in Japan who worked 1 10 prefectures. The outcome variable experience past year. Community pharmacists' assessed using 3 subdomains Interprofessional Assertiveness Scale (IAS): nonassertive, assertive, aggressive self-expression. classified into 2 categories median IAS subdomain scores. Pharmacist characteristics compared group univariate analyses. Binomial logistic regression used examine assertiveness. Of 3346 invited, 963 included analysis. After adjustment, high assertive (adjusted odds ratio, 1.49; 95 % confidence interval, 1.02-2.20; p = 0.042). No associations nonassertive or higher levels more likely deprescribing.

Language: Английский

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Management of fall-risk-increasing drugs in Australian aged care residents: a retrospective cross-sectional study

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: March 28, 2025

Globally, falls are considered a serious healthcare problem for aged care residents. Fall-risk-increasing drugs (FRIDs) medications that can increase the risk of falling, given their adverse effects. Medication reviews advocated to identify potentially inappropriate use FRIDs. However, impact on clinical and resident-centered outcomes is unclear. This study explored residents' FRIDs content medication review reports concerning these. A retrospective cross-sectional completed between 1st July 2021 30th June 2022 was conducted. Statistical descriptive analysis used examine (defined as listed in Screening Tool Older Persons Prescriptions older adults with high fall (STOPPFall)). The resident's medicine experience, identified drug-related problems (DRPs), related recommendations were via analysis. For deprescribe FRIDs, situations detailed compared those presented STOPPFall. relating 966 residents analysed. Of these residents, 83.2% (n = 804) 31.2% 301) taking three or more In total, pharmacists made 2635 DRPs, which 19.7% 520) deprescribing recommended. situation most frequently recommended FRID an indication limited benefit 37.9% 197). not 130 (25.0%) only included viewpoint deprescribing. found be highly prevalent among Pharmacists opportunities often omitted resident viewpoints grounds Using communication could improve outcomes.

Language: Английский

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Development of a complex multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty and polypharmacy

PLoS ONE, Journal Year: 2025, Volume and Issue: 20(4), P. e0319615 - e0319615

Published: April 22, 2025

Introduction Reducing polypharmacy and overprescribing in older people living with frailty is challenging. Evidence suggests that this could be facilitated by structured medication review (SMR) deprescribing processes involving the multidisciplinary team (MDT). This study aimed to develop an MDT SMR intervention primary care for frailty. Methods Intervention development was informed Medical Research Council framework complex behaviour change implementation theories. planning included: 1) a realist of 28 papers identified 33 context-mechanism-outcome configurations successful care, 2) qualitative 26 healthcare professionals (HCPs), 13 their informal carers. The intervention’s guiding principles were developed functions proposed, discussed refined through iterative process four online co-design stakeholder workshops. Results final version consisted five components: Proactive identification patients targeted using routinely collected data; HCPs’ preparation evidence-based tool identify prioritise high-risk medications deprescribing; 3) Preparing carers leaflet sent prior explaining purpose reasons potentially stopping or changing medications; 4) Conducting person-centred face-to-face phone, tailored patient/carer needs, other members based on expertise; 5) Tailored follow-up plans allowing continuity highlighting signs symptoms monitor, arranging text, phone appointment. Conclusion A address multiple challenges deprescribing. use rigorous methods theories maximises feasibility, acceptability implementation.

Language: Английский

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Deprescribing medications among patients with multiple prescribers: A socioecological model

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 72(3), P. 660 - 669

Published: Nov. 9, 2023

Abstract Deprescribing is the intentional dose reduction or discontinuation of a medication. The development deprescribing interventions should take into consideration important organizational, interprofessional, and patient‐specific barriers that can be further complicated by presence multiple prescribers involved in patient's care. Patients who receive care from an increasing number may experience disruptions timely transfer relevant healthcare information, risk exposure to drug–drug interactions other medication‐related problems. Furthermore, fragmentation information across health systems contribute refilling discontinued medications, reducing effectiveness interventions. Thus, must carefully consider unique characteristics patients their ensure are successfully implemented. In this special article, international working group physicians, pharmacists, nurses, epidemiologists, researchers United States Research Network (USDeN) developed socioecological model understand how influence implementation intervention at individual, interpersonal, societal level. This manuscript also includes description concept outlines research agenda for future investigations consider. contained used as framework successful service effective possible.

Language: Английский

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