Deprescribing Anticholinergic and Sedative Drugs to Reduce Polypharmacy in Frail Older Adults Living in the Community: A Randomized Controlled Trial

The Journals of Gerontology Series A, Journal Year: 2023, Volume and Issue: 78(9), P. 1692 - 1700

Published: Jan. 24, 2023

Polypharmacy is associated with poor outcomes in older adults. Targeted deprescribing of anticholinergic and sedative medications may improve health for frail Our pharmacist-led intervention was a pragmatic 2-arm randomized controlled trial stratified by frailty. We compared usual care (control) the pharmacists providing recommendations to general practitioners.

Language: Английский

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Leveraging implementation science to increase the translation of deprescribing evidence into practice

Research in Social and Administrative Pharmacy, Journal Year: 2021, Volume and Issue: 18(3), P. 2550 - 2555

Published: June 6, 2021

Language: Английский

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Healthcare Professional Perspectives on Managing Medications in Older People in Different Healthcare Settings

Advanced clinical pharmacy - research, development and practical applications/Advanced clinical pharmacy - research, development and practical applications, Journal Year: 2025, Volume and Issue: unknown, P. 255 - 277

Published: Jan. 1, 2025

Language: Английский

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Impact of the Goal‐directed Medication Review Electronic Decision Support System on Drug Burden Index: A cluster‐randomised clinical trial in primary care

British Journal of Clinical Pharmacology, Journal Year: 2020, Volume and Issue: 87(3), P. 1499 - 1511

Published: Sept. 22, 2020

The Goal-directed Medication Review Electronic Decision Support System (G-MEDSS) assesses and reports a patient's goals, attitudes to deprescribing Drug Burden Index (DBI) score, measure of cumulative exposure anticholinergic sedative medications. This study evaluated the effect implementing G-MEDSS in home medicines reviews (HMRs) on DBI clinical outcomes.A cluster-randomised trial was performed across Australia. Accredited pharmacists were randomised into intervention (G-MEDSS with usual care HMR) or comparison groups (usual HMR alone). Patients recruited by from those routinely referred general practitioners for HMR. primary outcome proportion patients any reduction at 3-months follow-up. Secondary outcomes included change continuous score 3-months, recommendations outcomes.There 201 patient participants baseline (n = 88 intervention, n 113 comparison), 159 followed-up 63 96 comparison). not significantly different (intervention 17%, 11%; adjusted odds ratio 1.44, 95% confidence interval 0.56-3.80). Regarding secondary outcomes, there no difference 3-months. However, report made reduce greater than group 37%, 14%; 3.20, 1.50-6.90). No changes observed outcomes.Implementation within did patients' 3 months compared

Language: Английский

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Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review

Kidney360, Journal Year: 2021, Volume and Issue: 2(9), P. 1510 - 1522

Published: July 9, 2021

Due to age and impaired kidney function, older adults with disease are at increased risk of medication-related problems related hospitalizations. One proa ctive approach minimize this is deprescribing. Deprescribing refers the systematic process reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients’ quality life by aligning medications their goals care. For some patients, could involve less aggressive management diabetes and/or hypertension. In other instances, targets may include inappropriate that carry greater harm than benefit in adults, have questionable efficacy, including varying efficacy degree increase medication regimen complexity. We guide for clinicians utilize deprescribing, List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations each step be tailored context individu al patients. Patient characteristics clinical events warrant consideration limited expectancy, cognitive impairment, health status changes, such as dialysis initiation recent hospitalization. acknowledge patient-, clinician-, system-level challenges depre scribing process. These patient hesitancy discussing care, clinician time constraints lack evidence-based guidelines, interoperable electronic records incentives However, novel tools designed facilitate future evidence on effectiveness help mitigate these barriers. This review foundational knowledge an emerging component practice research within nephrology.

Language: Английский

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Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool

BMC Medical Informatics and Decision Making, Journal Year: 2021, Volume and Issue: 21(1)

Published: April 5, 2021

Abstract Background Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood adverse drug events, practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like Drug Burden Index (DBI), help prioritise patients for medication review medications to deprescribe, but are integrated within routine care. The aim this study was conduct formative usability testing a computerised decision support (CDS) tool, based on DBI, identify modifications required tool prior trialling practice. Methods Our CDS comprised DBI MPage electronic medical record (clinical workspace) facilitated patient’s list, access resources, ability deprescribe. Two rounds scenario-based with think-aloud protocol were used. Seventeen end-users participated testing, including junior senior doctors, pharmacists. Results Participants expressed positive views about revealed number clear areas improvement. These primarily related terminology used (i.e. what how it calculated?), consistency functionality display. A key finding users wanted look function similar way other tools record. Modifications made response user feedback. Conclusion Usability proved extremely useful identifying components our confusing, difficult locate or understand. We recommend be adopted implementation any digital health intervention. hope revised equips clinicians knowledge confidence consider discontinuation inappropriate care hospitalised patients. In next phase project, we plan pilot test evaluate its uptake effectiveness supporting

Language: Английский

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The Prognostic Utility of Anticholinergic Burden Scales: An Integrative Review and Gap Analysis

Drugs & Aging, Journal Year: 2023, Volume and Issue: 40(9), P. 763 - 783

Published: July 18, 2023

Language: Английский

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Clinical pharmacists’ reported approaches and processes for undertaking Home Medicines Review services: A national survey

Archives of Gerontology and Geriatrics, Journal Year: 2023, Volume and Issue: 109, P. 104965 - 104965

Published: Feb. 16, 2023

Language: Английский

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MediQuit, an Electronic Deprescribing Tool for Patients on Polypharmacy: Results of a Feasibility Study in German General Practice

Drugs & Aging, Journal Year: 2021, Volume and Issue: 38(8), P. 725 - 733

Published: July 12, 2021

Deprescribing is an important task for general practitioners (GPs) in the face of risky polypharmacy. The electronic tool "MediQuit" was developed to guide GPs and patients through a deprescribing consultation that entails drug-selection phase, shared decision making, advice on safe implementation. A pilot study conducted determine target group selected assess impact, patient involvement, feasibility tool. This uncontrolled study. from two German regions were invited use MediQuit consultations with view one drug, if appropriate. They basis broad inclusion criteria. Collected data entailed participants' characteristics, patients' medication lists, deprescribed drugs, assessments. Patients contacted shortly after again 4 weeks. In total, 16 agreed participate, whom ten actually performed consultations. 41 predominately older excessive achieved 70% agreement patients. Drugs symptom-lowering preventive drugs (mainly anatomical therapeutic chemical classes C). found useful initiating communication this issue enhancing deliberations decision. median length 15 min (interquartile range 10–20). At follow-up, infrequently disagreed which drug(s) discontinued, rated involvement higher than did themselves. assists identifying concrete opportunities, making. three-step procedure well-accepted once initial organizational efforts are overcome. After revision, further studies needed enhance quality evidence acceptance effectiveness.

Language: Английский

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Diagnosis of Sarcopenic Dysphagia in the Elderly: Critical Review and Future Perspectives

Dysphagia, Journal Year: 2021, Volume and Issue: 37(5), P. 1093 - 1102

Published: Sept. 17, 2021

Language: Английский

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