Reducing Inappropriate Polypharmacy

JAMA Internal Medicine, Journal Year: 2015, Volume and Issue: 175(5), P. 827 - 827

Published: March 23, 2015

Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor inappropriate prescribing risk events patients is the number prescribed drugs. Deprescribing process tapering or stopping drugs, aimed at minimizing polypharmacy improving patient outcomes. Evidence efficacy for deprescribing emerging from randomized trials observational studies. A protocol proposed comprising 5 steps: (1) ascertain all drugs currently taking reasons each one; (2) consider overall drug-induced harm individual determining required intensity intervention; (3) assess regard to its current future benefit potential compared with potential; (4) prioritize discontinuation that have lowest benefit-harm ratio likelihood withdrawal reactions disease rebound syndromes; (5) implement regimen monitor closely improvement outcomes onset effects. Whereas prescriber barriers exist, resources strategies are available facilitate deliberate yet judicious deserve wider application.

Language: Английский

---

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

---

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

British Journal of Clinical Pharmacology, Journal Year: 2016, Volume and Issue: 82(3), P. 583 - 623

Published: April 15, 2016

Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed determine whether or not deprescribing safe, effective and feasible modify mortality health outcomes in older adults.

Language: Английский

---

Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults

JAMA, Journal Year: 2018, Volume and Issue: 320(18), P. 1889 - 1889

Published: Nov. 13, 2018

Importance

High rates of inappropriate prescribing persist among older adults in many outpatient settings, increasing the risk adverse drug events and drug-related hospitalizations.

Objective

To compare effectiveness a consumer-targeted, pharmacist-led educational intervention vs usual care on discontinuation medication community-dwelling adults.

Design, Setting, Participants

A cluster randomized trial (D-PRESCRIBE [Developing Pharmacist-Led Research to Educate Sensitize Community Residents Inappropriate Prescriptions Burden Elderly]) that recruited community pharmacies Quebec, Canada, from February 2014 September 2017, with follow-up until 2018, randomly allocated them or control groups. Patients included were aged 65 years who prescribed 1 4 Beers Criteria medications (sedative-hypnotics, first-generation antihistamines, glyburide, nonsteroidal anti-inflammatory drugs), 69 pharmacies. screened enrolled before randomization.

Interventions

Pharmacists group encouraged send patients an deprescribing brochure parallel sending their physicians evidence-based pharmaceutical opinion recommend deprescribing. The pharmacists provided care. Randomization occurred at pharmacy level, 34 (248 patients) 35 (241 patients). Patients, physicians, pharmacists, evaluators blinded outcome assessment.

Main Outcomes Measures

Discontinuation prescriptions for 6 months, ascertained by renewal profiles.

Results

Among 489 (mean age, 75 years; 66% women), 437 (89%) completed (219 [88%] 218 [91%] group). At 106 248 (43%) no longer filled compared 29 241 (12%) (risk difference, 31% [95% CI, 23% 38%]). In group, 63 146 sedative-hypnotic users (43.2%) 14 155 (9.0%), respectively 34% 25% 43%]); 19 62 glyburide (30.6%) 8 58 (13.8%), 17% 2% 31%]); 33 (57.6%) 5 23 (21.7%), 35% 10% 55%]) (Pfor interaction = .09). Analysis antihistamine class was not possible because small sample size (n 12). No requiring hospitalization reported, although 77 (38%) attempted taper sedative-hypnotics reported withdrawal symptoms.

Conclusions Relevance

resulted greater after months. generalizability these findings other settings requires further research.

Trial Registration

ClinicalTrials.gov Identifier:NCT02053194

Language: Английский

---

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

---

Benzodiazepine Use in Older Adults: Dangers, Management, and Alternative Therapies

Mayo Clinic Proceedings, Journal Year: 2016, Volume and Issue: 91(11), P. 1632 - 1639

Published: Nov. 1, 2016

Language: Английский

---

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

---

Deprescribing in Frail Older People: A Randomised Controlled Trial

PLoS ONE, Journal Year: 2016, Volume and Issue: 11(3), P. e0149984 - e0149984

Published: March 4, 2016

Objectives Deprescribing has been proposed as a way to reduce polypharmacy in frail older people. We aimed the number of medicines consumed by people living residential aged care facilities (RACF). Secondary objectives were explore effect deprescribing on survival, falls, fractures, hospital admissions, cognitive, physical, and bowel function, quality life, sleep. Methods Ninety-five over 65 years four RACF rural mid-west Western Australia randomised an open study. The intervention group (n = 47) received intervention, planned cessation non-beneficial medicines. control 48) usual care. Participants monitored for twelve months from randomisation. Primary outcome was change mean unique regular All outcomes assessed at baseline, six, months. Results Study participants had age 84.3±6.9 52% female. Intervention 9.6±5.0 9.5±3.6 baseline. Of 348 targeted (7.4±3.8 per person, 78% medicines), 207 (4.4±3.4 59% medicines) successfully discontinued. 12 -1.9±4.1 +0.1±3.5 (estimated difference 2.0±0.9, 95%CI 0.08, 3.8, p 0.04). Twelve 19 died within randomisation (26% versus 40% mortality, 0.16, HR 0.60, 0.30 1.22) There no significant differences between groups other secondary outcomes. main limitations this study design small participant numbers. Conclusions reduced with adverse effects survival or clinical Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12611000370909

Language: Английский

---

Effectiveness of the STOPP/START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies

Journal of Clinical Pharmacy and Therapeutics, Journal Year: 2016, Volume and Issue: 41(2), P. 158 - 169

Published: March 17, 2016

What is known and objective STOPP/START are explicit screening tools that identify potentially inappropriate prescribing in older adults. Our was to update our 2013 systematic review showed limited evidence of impact, using new from randomized controlled trials (RCTs) assessing clinical, humanistic economic outcomes Methods We performed a search PubMed, EMBASE, CINAHL, Web Science grey literature for RCTs published English since the previous through June 2014. The Cochrane Risk Bias Tool used. meta-analysis on effect STOPP medication (PIM) rates narrative synthesis other outcomes. Results discussion Four (n = 1925 adults) four countries were included, reporting both acute 2) long-term care patients. Studies differed implementation. Two studies judged have low risk, two moderate-to-high risk bias key domains. Meta-analysis found criteria reduced PIM all studies, but study heterogeneity (I2 86·7%) prevented calculation meaningful statistical summary. use reduces falls, delirium episodes, hospital length-of-stay, visits (primary emergency) costs, no improvements quality life or mortality. conclusion may be effective improving quality, Additional research investigating these needed, especially frail elderly community-living patients receiving primary care.

Language: Английский

---

Challenges and Enablers of Deprescribing: A General Practitioner Perspective

PLoS ONE, Journal Year: 2016, Volume and Issue: 11(4), P. e0151066 - e0151066

Published: April 19, 2016

Aims Deprescribing is the process of reducing or discontinuing medicines that are unnecessary deemed to be harmful. We aimed investigate general practitioner (GP) perceived challenges deprescribing in residential care and possible enablers support GPs implement deprescribing. Methods A qualitative study was undertaken using semi-structured, face-to-face interviews from two cities New Zealand a purpose-developed pilot-tested interview schedule. Interviews were recorded with permission transcribed verbatim. Transcripts read re-read themes identified iterative building coding list until all data accounted for. continued saturation ideas occurred. Analysis carried out assistance Theoretical Domains Framework (TDF) constant comparison techniques. Several identified. Challenges determined based on participants' answers. Results Ten agreed participate. Four define issues around prescribing for older people, GPs' perspectives. Theme 1, 'recognition problem', discusses difficulties involved people. 2 outlines behaviour change factors relevant problem. drawn these summarised 3 under three major headings; 'prescribing factors', 'social influences' 'policy processes'. enablers, opinions professional experience GPs, retrieved 4. Conclusion The laced many GPs. uncertainty research evidence people social such as specialists' nurses' influences among encompassed awareness knowledge, improvement communication between multiple prescribers, adequate reimbursement pharmacists being multidisciplinary team.

Language: Английский

---