Multidisciplinary DEprescribing review for Frail oldER adults in long-term care (DEFERAL): Implementation strategy design using behaviour science tools and stakeholder engagement

Research in Social and Administrative Pharmacy, Journal Year: 2023, Volume and Issue: 19(8), P. 1202 - 1213

Published: May 12, 2023

Deprescribing is a strategy for reducing the use of potentially inappropriate medications older adults. Limited evidence exists on development strategies to support healthcare professionals (HCPs) deprescribing frail adults in long-term care (LTC). To design an implementation strategy, informed by theory, behavioural science and consensus from HCPs, which facilitates LTC. This study was consisted 3 phases. First, factors influencing LTC were mapped behaviour change techniques (BCTs) using Behaviour Change Wheel two published BCT taxonomies. Second, Delphi survey purposively sampled HCPs (general practitioners, pharmacists, nurses, geriatricians psychiatrists) conducted select feasible BCTs deprescribing. The rounds. Using results literature used effective interventions, could form shortlisted research team based acceptability, practicability effectiveness. Finally, roundtable discussion held with purposeful, convenience sample general pharmacists nurses prioritise tailor proposed Factors 34 BCTs. completed 16 participants. Participants reached that 26 feasible. Following assessment, 21 included roundtable. identified lack resources as primary barrier address. agreed incorporated 11 education-enhanced 3-monthly multidisciplinary review, led nurse, at site. incorporates HCPs' experiential understanding nuances thus addresses systemic barriers this context. designed five determinants best engaging

Language: Английский

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Gyógyszerrosta: a racionális gyógyszeres terápia meghatározó eleme

Orvosi Hetilap, Journal Year: 2023, Volume and Issue: 164(24), P. 931 - 941

Published: June 18, 2023

A gyógyszerrosta (az angol deprescribing magyar megfelelője) tervezett, szisztematikus gyógyszerleépítési folyamat, amely egészségügyi szakember felügyeletével zajlik, és lényegében a helyes gyógyszerrendelési gyakorlat részének tekintendő. nemcsak teljes gyógyszerelhagyást jelentheti, hanem dóziscsökkentés folyamata is lehet. Megtervezése során létfontosságú figyelembe venni terápiás célkitűzéseket, valamint beteg egészségi állapotát, időbeli életkilátását, értékrendjét igényeit. célja betegenként változhat, alapvetően azonban prioritásnak tekinthető számára fontos célok elérése, életminőségének javítása. Közleményünkben nemzetközi szakirodalom alapján áttekintjük folyamatának lehetséges célpontjait: azokat nagy kockázatú betegcsoportokat, amelyeknél előnyös lehet gyógyszerleépítés; gyógyszereket gyógyszercsoportokat, amelyek szedése esetén szükség terápia felülvizsgálatára; összefoglaljuk folyamat színtereit. Ezenkívül kitérünk általános lépéseire, előnyeire, kockázataira, ismertetjük rendelkezésre álló specifikus irányelveket, algoritmusokat. Részletesen tárgyaljuk folyamatot segítő hátráltató tényezőket, mind az szakemberek, pedig betegek szemszögéből, végül kezdeményezésekre jövőjére is. Orv Hetil. 2023; 164(24): 931–941.

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Challenges in Deprescribing among Older Adults in Post-Acute Care Transitions to Home

Journal of the American Medical Directors Association, Journal Year: 2023, Volume and Issue: 25(1), P. 138 - 145.e6

Published: Oct. 29, 2023

Language: Английский

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Clinician and Family Caregiver Perspectives on Deprescribing Chronic Disease Medications in Older Nursing Home Residents Near the End of Life

Drugs & Aging, Journal Year: 2024, Volume and Issue: 41(4), P. 367 - 377

Published: April 1, 2024

Language: Английский

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Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(8), P. 2347 - 2358

Published: June 3, 2024

Abstract Background The use of potentially inappropriate medications (PIMs) is associated with increased risk hospitalizations and emergency room visits varies by racial ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive review (CMR) to all beneficiaries who qualify, provides a platform reduce PIM use. objective this study was assess the impact CMR on discontinuation in Medicare whether differed race or ethnicity. Methods Retrospective cohort community‐dwelling ≥66 years age were eligible for MTM from 2013 2019 based 5% fee‐for‐service claims data linked 100% file. Among those using PIM, MTM‐eligible recipients matched non‐recipients via sequential stratification. probability estimated regression models pooled yearly subcohorts accounting within‐beneficiary correlations. most common PIMs discontinued after reported. Results We 24,368 during observation period. Median 74–75, 35% males, White (86%–87%), median number 1. In adjusted analyses, receipt positively (adjusted relative [aRR]: 1.26, 95% CI: 1.20–1.32). There no evidence differential commonly glimepiride, zolpidem, digoxin, amitriptyline, nitrofurantoin. Conclusions are discontinuation, suggesting greater could facilitate reduction groups.

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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Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study

BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)

Published: July 8, 2024

Abstract Purpose Multimorbidity and polypharmacy in older adults converts the detection adequacy of potentially inappropriate drug prescriptions (PIDP) a healthcare priority. The objectives this study are to describe clinical decisions taken after identification PIDP by pharmacists, using STOPP/START criteria, evaluate degree accomplishment these decisions. Methods Multicenter, prospective, non-comparative cohort patients aged 65 older, hospitalized because an exacerbation their chronic conditions. Each possible was manually identified pharmacist at admission initial decision multidisciplinary committee. At discharge, criteria were re-applied final recorded. Results From all (n = 674), 493 (73.1%) presented least one STOPP admission, significantly reduced up 258 (38.3%) discharge. A similar trend observed for START (36.7% vs. 15.7%). Regarding top 10 most prevalent committee initially agreed withdraw 257 (34.2%) modify 93 (12.4%) prescriptions. However, evaluation revealed that 503 (67.0%) those ultimately amended. For associated PIDP, decided initiate 149 (51.7%) prescriptions, while total 198 (68.8%) finally introduced Conclusions committee, through pharmacotherapy review, succeeded identifying reducing prescription inadequacy, both with high multimorbidity polypharmacy. Trial Registration NCT02830425.

Language: Английский

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A quantitative study on the impact of a community falls pharmacist role, on medicines optimisation in older people at risk of falls

BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)

Published: July 15, 2024

The World Falls guidance includes medication review as part of its recommended multifactorial risk assessment for those at high falling. Use Risk Increasing Drugs (FRIDs) along with polypharmacy and anticholinergic burden (ACB) are known to increase the falls in older people.

Language: Английский

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Inpatient referrals to a specialist falls and syncope service: prevalence of STOPPFall FRIDs and review of deprescribing patterns

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

Published: Nov. 23, 2024

Language: Английский

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Barriers and facilitators to implementing polypharmacy management frameworks: a theory based qualitative exploration of key stakeholders

International Journal of Clinical Pharmacy, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 12, 2024

Abstract Background Inappropriate polypharmacy arises through many factors including deficiencies in prescribing processes. Most research has focused on solutions at the clinician/patient levels with less organisational level. Aim To explore key stakeholder identified barriers and facilitators to implementation of an level management framework. Method Qualitative data were collected within Ministry Health Oman. Key stakeholders purposively sampled encompassing senior representatives pharmacy, medicine, nursing directors; healthcare policymakers; patient safety leaders; academic leaders. A semi-structured interview schedule was developed informed by a recent scoping review underpinned Consolidated Framework for Implementation Research (CFIR). Interviews, which continued until saturation, audio-recorded, transcribed analysed using Approach. Results Thirteen interviewed, representation each target group. Facilitators largely mapped CFIR domain inner setting (i.e., aspects awareness, electronic health system national leadership), intervention characteristic (evidence gaps), characteristics individuals (stakeholders champions) process (change strategy). Barriers also (policy absence, communication professional practice) outer (resource needs). Conclusion This study illuminated Further work is required translate these themes into actionable plan implement Particular attention internal context occurs) as most this domain.

Language: Английский

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