Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(3), P. e241342 - e241342

Published: March 6, 2024

Importance Guidelines recommend deprescribing opioids in older adults due to risk of adverse effects, yet little is known about patient-clinician opioid conversations. Objective To understand the experiences and primary care practitioners (PCPs) with using for chronic pain discussing deprescribing. Design, Setting, Participants This qualitative study conducted semistructured individual interviews 18 PCPs 29 65 years or prescribed between September 15, 2022, April 26, 2023, at a Boston-based academic medical center. The were asked their prescribing adults. Patients medications PCPs. Main Outcome Measures Shared conflicting themes patients regarding perceptions barriers Results In total, (12 [67%] younger that 50 years; 10 [56%] female; 14 [78%] based an practice) (mean [SD] age, 72 [5] 19 [66%] female) participated. conveyed conversations on use typically challenging risks uncommon. Three common related emerged both patient PCP interviews: used as last resort, improve function quality life, trust was vital clinician-patient relationship. expressed views opioids, focusing addiction drug events. Both groups felt often unsuccessful but had successful unnecessary unless event occurred, many prior negative tapering. described gaps knowledge how taper, lack clinical access monitor during tapering, concerns resistance. Conclusions Relevance this study, receiving long-term therapy viewed beneficial resort treating dissonant associated which made challenging. Interventions, such conversation aids, are needed support collaborative discussion opioids.

Language: Английский

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Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper

European Geriatric Medicine, Journal Year: 2023, Volume and Issue: 14(6), P. 1195 - 1209

Published: Oct. 9, 2023

Abstract Inappropriate polypharmacy is highly prevalent among older adults and presents a significant healthcare concern. Conducting medication reviews implementing deprescribing strategies in multimorbid with are an inherently complex challenging task. Recognizing this, the Special Interest Group on Pharmacology of European Geriatric Medicine Society has compiled evidence review formulated recommendations to enhance appropriate prescribing practices. The current supports need for comprehensive widespread transformation education, guidelines, research, advocacy, policy improve management individuals. Furthermore, incorporating as routine aspect care ageing population crucial. We emphasize importance involving geriatricians experts geriatric pharmacology driving, actively participating this transformative process. By doing so, we can work towards achieving optimal use enhancing well-being generations come.

Language: Английский

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Low back pain-related healthcare utilization following intraosseous basivertebral nerve radiofrequency ablation: a pooled analysis from three prospective clinical trials

Pain Medicine, Journal Year: 2023, Volume and Issue: 25(1), P. 20 - 32

Published: Aug. 29, 2023

Abstract Background The effectiveness and safety of intraosseous basivertebral nerve ablation (BVNA) for treating vertebrogenic pain is established, but low back pain-related healthcare utilization (LBPr-HU) following BVNA continues to be defined. Methods LBPr-HU data were pooled from 3 prospective studies. categories interest included non-invasive conservative care, opioid utilization, lumbosacral spinal injection (LSI), radiofrequency (LRFA), surgery. Pre- post-BVNA compared at both 1- 5-years using McNemar’s test proportions paired t-tests means. Results Two hundred forty-seven patients received had 1-year follow-up; 205 long-term follow-up (mean 5.3 ± 1.33 years). Twenty-seven percent fewer participants initiated care in the year preceding (P < .001; 95% CI 19.8–34.5). Of 77/247 taking opioids baseline, 40.3% 61.7% them one-year years post-BVNA, respectively .001). receiving LSIs BVNA, 81.2% LSI(s) 70.7–90.7); a 76.4% reduction was maintained through mean post-BVNA. LRFA rates 1.6% 8.3% Lumbar fusion surgery 0.8% 6.5% Conclusions In this aggregate analysis with pain, opioids, LSIs, substantially reduced 5 baseline. less than half published value similar populations.

Language: Английский

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Minimising Harm and Managing Pain: Deprescribing Opioids in Older Adults

Drugs & Aging, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 29, 2024

Language: Английский

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Medication use quality and safety in older adults: 2022 update

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 72(5), P. 1329 - 1337

Published: Dec. 1, 2023

Abstract Improving the quality of medication use and safety are important priorities for healthcare providers who care older adults. The objective this article was to identify four exemplary articles with focus in 2022. We selected high‐quality studies from an OVID search hand searching major high impact journals that advanced field research forward. chosen cover domains related deprescribing, safety, optimizing use. MedSafer Study, a cluster randomized clinical trial Canada, evaluated whether patient specific deprescribing reports generated by electronic decision support software resulted reduced adverse drug events 30 days post hospital discharge adults (domain: deprescribing). second study, retrospective cohort study using data Premier Healthcare Database, examined in‐hospital associated perioperative gabapentin among undergoing surgery safety). third used open‐label parallel controlled 39 Australian aged‐care facilities examine effectiveness pharmacist‐led intervention reduce medication‐induced deterioration reactions use). Lastly, fourth engaged experts Delphi method process develop consensus list clinically prescribing cascades adversely affect persons' health aid clinicians identify, prevent, manage Collectively, review succinctly highlights pertinent topics promoting safe medications promotes awareness adults' regimens.

Language: Английский

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Issue Information

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 71(5), P. 1351 - 1357

Published: May 1, 2023

WHO WE AREFounded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals dedicated to improving health, independence, and quality life older people.Our members include thousands geriatricians, advanced practice nurses, social workers, family practitioners, physician assistants, pharmacists, internists who are pioneers advanced-illness care for individuals, with focus on championing interprofessional teams, eliciting personal goals, treating people as whole persons.The provides leadership professionals, policymakers, public by implementing advocating programs clinical care, research, professional education, policy that can support us all we age. OUR MISSIONTo improve people. VISION FOR THE FUTUREWe able contribute our communities maintain safety, independence age.We have access high-quality, person-centered informed principles free ageism.We supported where ageism, ableism, classism, homophobia, racism, sexism, xenophobia, other forms bias discrimination no longer impact access, quality, outcomes adults their caregivers. STRATEGIES ACHIEVING VISION1. Expanding knowledge base disseminating basic, clinical, health services research focused people.2. Increasing number employing when caring diverse persons supporting integration concepts into education.3. Recruiting trainees focusing rewards potential career people.4. Advocating promotes Americans, goal life, systems serving 5. Creating awareness about ways remaining active, independent, engaged communities.6. Working across strategic priorities identify eliminate structural bias/discrimination given LEARN MOREVisit www.americangeriatrics.org learn more its programs.

Language: Английский

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