The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis

British Journal of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 20, 2024

Abstract Aims Previous systematic reviews suggest that deprescribing may improve survival, particularly in frail older people. Evidence is rapidly accumulating, suggesting a need for an updated review of the literature. Methods We 2016 and meta‐analysis to include studies published from inception 26 April 2024 specified databases. Studies which people had at least one medication deprescribed were included grouped by study designs targeted medications. The risk bias was assessed using Cochrane tool Newcastle‐Ottawa tool. Odds ratios (OR) or mean differences calculated as effect measures either Mantel–Haenszel generic inverse‐variance method with fixed‐ random‐effects meta‐analyses. primary outcome mortality. Secondary outcomes adverse drug withdrawal events, physical health, cognitive function, quality life on regimen. Subgroup analyses performed based age intervention types. Results A total 259 (reported 286 papers) this review. Deprescribing polypharmacy did not result significant reduction mortality both randomized (OR 0.96, 95% confidence interval [CI] 0.84–1.09) non‐randomized 0.70, CI 0.36–1.38). Further subgroup demonstrated young old (aged 65–79) 0.71, 0.51–0.99) when patient‐specific interventions applied 0.79, 0.63–0.99). Conclusions can be achieved potentially important benefits terms improved are initiated early old.

Language: Английский

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Deprescribing, shared decision-making, and older people: perspectives in primary care

Journal of Pharmaceutical Policy and Practice, Journal Year: 2023, Volume and Issue: 16(1)

Published: Nov. 27, 2023

Polypharmacy is an issue that affects many people, especially older adults, and could result in negative outcomes such as lower medication adherence increase the likelihood of adverse drug reactions. Deprescribing a possible solution to mitigating this issue. Examining polypharmacy deprescribing primary care settings important it help adults living community their relatives by lowering treatment burden cost. Some guidelines have been developed with process; however, these are not applicable all patients situations. Thus, process needs be based mainly on patient's current situations, preferences, values achieved using shared decision-making. However, some barriers slow down deprescribe measures should taken overcome barriers. This review aims examine situation deprescribing, settings, how SDM can used optimize process. To achieve illustration one prominent model will presented showcase

Language: Английский

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Survey content validation evaluating the dissemination and implementation of deprescribing guidelines

Basic & Clinical Pharmacology & Toxicology, Journal Year: 2023, Volume and Issue: 134(1), P. 63 - 71

Published: June 26, 2023

Policies, protocols and processes within organisations can facilitate or hinder guideline adoption. There is limited knowledge on the strategies used by to disseminate implement evidence-based deprescribing guidelines their impact.We aimed develop an online survey targeting key involved in endorsement, dissemination, modification translation internationally. Survey questions were drafted, mirroring six components of reach, effectiveness, adoption, implementation maintenance (RE-AIM) framework. Content validation was undertaken established a panel clinicians, researchers experts.A 52-item underwent two rounds content validation. The minimum threshold (I-CVI > 0.78) for relevance importance met 39 items (75%) first round 44 48 (92%) second round. expert concluded that effectiveness sections largely relevant important this topic, whereas reach harder understand may be less pertinent research question.A 44-item investigating dissemination has been developed its validated. Widespread distribution identify effective inform planning newly guidelines.

Language: Английский

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How does deprescribing (not) reduce mortality? A review of a meta‐analysis in community‐dwelling older adults casts uncertainty over claimed benefits

Basic & Clinical Pharmacology & Toxicology, Journal Year: 2023, Volume and Issue: 134(1), P. 51 - 62

Published: June 28, 2023

Some meta-analyses suggest that deprescribing may reduce mortality. Our aim was to determine the underlying factors contributing this observed reduction. We analysed data from 12 randomized controlled trials included in latest meta-analysis on community-dwelling older adults. analysis focused deprescribed medications and potential methodological concerns. Only a third (4/12) of aimed study mortality, too as secondary outcome. Five reported reduction total medications, potentially inappropriate or drug-related problems. Information specific classes limited, although wide array concerned (e.g., antihypertensive, sedative, gastro-intestinal vitamins). Follow-up periods were ≤1 year 11 trials, five ≤150 participants. Small sample sizes often resulted imbalanced groups comorbidities, number medications), yet no presented multivariable analyses. In two with most weight meta-analysis, several deaths occurred before intervention, making it difficult draw conclusions about impact intervention These issues cast significant uncertainty benefits mortality outcomes. Large-scale, well-designed are needed address issue effectively.

Language: Английский

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eConsultation for Deprescribing Among Older Adults: Clinician Perspectives on Implementation Barriers and Facilitators

Journal of General Internal Medicine, Journal Year: 2024, Volume and Issue: 39(13), P. 2461 - 2470

Published: June 28, 2024

Language: Английский

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Awareness, perspectives and practices of antibiotics deprescribing among physicians in Jordan: a cross-sectional study

Journal of Pharmaceutical Policy and Practice, Journal Year: 2024, Volume and Issue: 17(1)

Published: July 19, 2024

Background: Antibiotics have significantly reduced mortality and improved outcomes across various medical fields; however, the rise of antibiotic resistance poses a major challenge, causing millions deaths annually. Deprescribing, process that involves discontinuing unnecessary antibiotics, is crucial for combating this threat. This study was designed to assess knowledge, perceptions, practices physicians regarding deprescribing in Jordan.

Language: Английский

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Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective and interventions to support a proactive approach

Expert Review of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: 17(8), P. 637 - 654

Published: Aug. 2, 2024

For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, rates these so-called cardiometabolic medications are low. A review challenges interventions addressing in this population pertinent.

Language: Английский

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Deprescribing Proton Pump Inhibitors (Ppis): Updated Clinical Guidelines

Published: Jan. 1, 2024

Language: Английский

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Deprescribing Proton Pump Inhibitors: Updated Clinical Guidelines

The Journal for Nurse Practitioners, Journal Year: 2024, Volume and Issue: 20(9), P. 105159 - 105159

Published: Aug. 19, 2024

Language: Английский

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Normalising the Implementation of Pharmacogenomic (PGx) Testing in Adult Mental Health Settings: A Theory-Based Systematic Review

Journal of Personalized Medicine, Journal Year: 2024, Volume and Issue: 14(10), P. 1032 - 1032

Published: Sept. 27, 2024

Pharmacogenomic (PGx) testing can help personalise psychiatric prescribing and improve on the currently adopted trial-and-error approach. However, widespread implementation is yet to occur. Understanding factors influencing pertinent PGx field. Normalisation Process Theory (NPT) seeks understand work involved during intervention used by this review (PROSPERO: CRD42023399926) explore in psychiatry. Four databases were systematically searched for relevant records assessed eligibility following PRISMA guidance. The QuADS tool was applied quality assessment of included records. Using an abductive approach codebook thematic analysis, barrier facilitator themes developed using NPT as a theoretical framework. Twenty-nine data synthesis. Key knowledge gap, lack consensus policy guidance, uncertainty towards use PGx. Facilitator interest new improved prescribing, desire multidisciplinary implementation, importance fostering climate implementation. NPT, novel summarises literature findings highlight need develop national policies PGx, education training workforce plan mental health professionals. By understanding address gap. This helps move clinical practice closer personalised psychotropic associated improvements patient outcomes. Future research should focus appraisal psychiatry role pharmacists service design, delivery.

Language: Английский

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