Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis

BMJ Open, Journal Year: 2014, Volume and Issue: 4(12), P. e006544 - e006544

Published: Dec. 1, 2014

Objective To synthesise qualitative studies that explore prescribers’ perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. Design A systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL INFORMIT from inception March 2014, combined with an extensive manual search of reference lists related citations. quality checklist used assess the transparency reporting included potential for bias. Thematic synthesis identified common subthemes descriptive themes across which analytical construct developed. Study characteristics were examined explain differences findings. Setting All healthcare settings. Participants Medical non-medical prescribers medicines Outcomes Prescribers’ perspectives on factors shape their behaviour towards continuing or discontinuing PIMs Results 21 included; most explored primary care physicians’ managing older, community-based Barriers emerged within four themes: problem awareness; inertia secondary lower value proposition ceasing versus PIMs; self-efficacy regard personal ability alter prescribing; feasibility altering prescribing routine environments given external constraints. The first three are intrinsic prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) fourth is extrinsic patient, work setting, health system cultural factors). practice setting influenced reported. Conclusions multitude highly interdependent PIMs. full understanding changing critical development targeted interventions aimed at deprescribing reducing risk iatrogenic harm.

Language: Английский

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A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

British Journal of Clinical Pharmacology, Journal Year: 2015, Volume and Issue: 80(6), P. 1254 - 1268

Published: Aug. 7, 2015

The aim of this study was to identify what definitions have been published for the term 'deprescribing', and determine whether a unifying definition could be reached. A secondary uncover patterns between which explain any variation.Systematic literature searches were performed (earliest records February 2014) in MEDLINE, Embase, CINAHL, Informit, Scopus Google Scholar. terms deprescrib* or de-prescrib* employed as keyword search all fields. Conventional content analysis word frequencies used characteristics definitions. Network conducted visualize characteristic distribution across authors articles.Following removal duplicates, 231 articles retrieved, 37 included definition. Eight identified: use stop/withdraw/cease/discontinue (35 articles), aspect prescribing e.g. long therapy/inappropriate medications (n = 18), 'process' 'structured' 13), withdrawal is planned/supervised/judicious 11), involving multiple steps 7), includes dose reduction/substitution desired goals/outcomes described 5) involves tapering 4). did not reveal responsible variations previously definitions.These findings show that there lack consensus on deprescribing. This article proposes following definition: 'Deprescribing process an inappropriate medication, supervised by health care professional with goal managing polypharmacy improving outcomes'. has yet externally validated further work required develop internationally accepted appropriate

Language: Английский

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Too much medicine in older people? Deprescribing through shared decision making

BMJ, Journal Year: 2016, Volume and Issue: unknown, P. i2893 - i2893

Published: June 3, 2016

Jansen and colleagues explore the role of shared decision making in tackling inappropriate polypharmacy older adults

Language: Английский

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Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action

European Journal of Internal Medicine, Journal Year: 2017, Volume and Issue: 38, P. 3 - 11

Published: Jan. 5, 2017

Language: Английский

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Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many

Drug Safety, Journal Year: 2015, Volume and Issue: 39(2), P. 109 - 116

Published: Dec. 21, 2015

The use of multiple medicines (polypharmacy) is increasingly common in middle-aged and older populations. Ensuring the correct balance between prescribing 'many' drugs 'too many' a significant challenge. Clinicians are tasked with ensuring that patients receive most appropriate combinations medications based on best available evidence, medication optimised according to patients' clinical needs (appropriate polypharmacy). Historically, polypharmacy has been viewed negatively because associated safety risks, such as drug interactions adverse events. More recently, identified risk factor for under-prescribing, do not necessary this can also pose risks well-being. negative connotations have long term could potentially be acting driving whereby clinicians reluctant prescribe who already receiving medicines. It now recognised entirely several chronic conditions events may greatly reduced when context taken into consideration. In article, we outline current perspectives make case adopting 'appropriate polypharmacy' differentiating drugs. We inherent challenges doing so provide recommendations future practice research.

Language: Английский

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Development and Validation of the Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire: Versions for Older Adults and Caregivers

Drugs & Aging, Journal Year: 2016, Volume and Issue: 33(12), P. 913 - 928

Published: Oct. 26, 2016

Language: Английский

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Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

JAMA Internal Medicine, Journal Year: 2018, Volume and Issue: 178(12), P. 1673 - 1673

Published: Oct. 16, 2018

Use of harmful and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance discontinuing medication use a significant barrier deprescribing.To describe the attitudes toward deprescribing determine whether individual characteristics are associated with these attitudes.For this population-based survey study US Medicare beneficiaries 65 years older, data were obtained from Medication Attitudes module fielded through in-person interviews round 6 National Health Aging Trends Study (weighted response rate was 88.5%). The questions drawn Patients' Towards Deprescribing questionnaire its revised version. random one-third (n = 2124) participants 94.8%).Responses 2 statements ("If my doctor said it possible, I would be willing stop one or more regular medicines" "I like reduce number medicines am taking") main outcomes interest.Of 1981 included study, 1149 (55.2%, weighted) women, majority 715 [54.6%, weighted]) 74 old. A total 1752 (92.0%, reported being taking 1 their if physician 1241 (66.6%, wanted they taking. Older had greater odds than those fewer (adjusted ratio, 2.90; 95% CI, 1.74-4.82) wanting 2.31; 1.71-3.13).Physicians considering part comprehensive, patient-centered should reassured Americans open having deprescribed says two-thirds want

Language: Английский

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STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs

Age and Ageing, Journal Year: 2020, Volume and Issue: 50(4), P. 1189 - 1199

Published: Oct. 30, 2020

Abstract Background Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier furthermore, there is no consensus on which medications considered as FRIDs despite several systematic reviews. To support clinicians in the management facilitate deprescribing process, STOPPFall (Screening Tool Older Persons Prescriptions older adults with high fall risk) tool were developed by European expert group. Methods was created two facilitators based evidence from recent meta-analyses national prevention guidelines Europe. Twenty-four panellists chose their level agreement Likert scale items three Delphi panel rounds. A threshold 70% selected for priori. The asked whether some agents more than others within same pharmacological class. In an additional questionnaire, cases should be how it performed. Results agreed 14 medication classes included STOPPFall. They mostly psychotropic medications. indicated 18 differences between subclasses regard properties. Practical guidance classes. Conclusion using process combined practical designed optimise review. effectiveness these tools falls further evaluated intervention studies.

Language: Английский

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Deprescribing for Community-Dwelling Older Adults: a Systematic Review and Meta-analysis

Journal of General Internal Medicine, Journal Year: 2020, Volume and Issue: 35(11), P. 3323 - 3332

Published: Aug. 20, 2020

Language: Английский

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Swimming Against the Tide: Primary Care Physicians’ Views on Deprescribing in Everyday Practice

The Annals of Family Medicine, Journal Year: 2017, Volume and Issue: 15(4), P. 341 - 346

Published: July 1, 2017

PURPOSE

Avoidable hospitalizations due to adverse drug events and high-risk prescribing are common in older people. Primary care physicians prescribe most on-going medicines. Deprescribing has long been essential best practice. We sought explore the views of primary on barriers facilitators deprescribing everyday practice inform development an intervention support safer prescribing.

METHODS

used a snowball sampling technique identify potential participants. Physicians were selected basis years practice, employment status, setting, with additional focus information-rich Twenty-four semistructured interviews audio-recorded, transcribed verbatim, analyzed emergent themes.

RESULTS

described as "swimming against tide" patient expectations, medical culture prescribing, organizational constraints. They said came inherent risks for both themselves patients conveyed sense vulnerability The only incentive they identified was duty do what right patient. recommended changes including targeted funding annual medicines review, computer prompts, improved information flows between prescribers, access expert advice user-friendly decision support, increased availability non-pharmaceutical therapies, enhanced engagement management.

CONCLUSIONS

Interventions should consider sociocultural, personal, relational, constraints deprescribing. Regulations policies be designed practicing according their professional ethical values.

Language: Английский

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