Journal of the American Medical Directors Association, Год журнала: 2024, Номер 25(8), С. 105005 - 105005
Опубликована: Апрель 24, 2024
Язык: Английский
BMJ, Год журнала: 2024, Номер unknown, С. e074892 - e074892
Опубликована: Май 7, 2024
Abstract Polypharmacy is common in older adults and associated with adverse drug events, cognitive functional impairment, increased healthcare costs, risk of frailty, falls, hospitalizations, mortality. Many barriers exist to deprescribing, but efforts have been made develop implement deprescribing interventions that overcome them. This narrative review describes intervention components summarizes findings from published randomized controlled trials tested polypharmacy, as well reports on ongoing trials, guidelines, resources can be used facilitate deprescribing. Most were medication reviews primary care settings, many contained such shared decision making and/or a focus patient priorities, training for professionals, facing education materials, involvement family members, representing great heterogeneity addressing polypharmacy adults. Just over half study found perform better than usual at least one their outcomes, most assessed 12 months or less.
Язык: Английский
Процитировано
20
Journal of the American Geriatrics Society, Год журнала: 2024, Номер 72(10), С. 3219 - 3238
Опубликована: Июнь 1, 2024
Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, reduce PIM prescriptions. This systematic meta-analysis experimental observational studies aimed evaluate impact different medication interventions in hospitalized older patients.
Язык: Английский
Процитировано
11
Journal of the American Geriatrics Society, Год журнала: 2025, Номер unknown
Опубликована: Март 28, 2025
ABSTRACT Background Polypharmacy is a major risk factor for adverse drug events (ADEs), which are common cause of hospitalization, especially among older adults. Deprescribing promising strategy to prevent ADEs; however, clinicians may hesitate deprescribe fear causing withdrawal (ADWEs). Collectively, ADWEs the re‐emergence symptoms or disease state due discontinuation medication. Although capturing critical understanding complications that might arise from deprescribing, these not be routinely systematically captured in clinical trials. Objectives We aimed determine frequency ADWE reporting, compare strengths and limitations different approaches, rates number detected across Methods A systematic review was performed following Preferred Reporting Items Systematic Reviews Meta‐Analyses checklist. The search developed with research librarian, studies were identified using Ovid Medline, Embase, Cochrane Central Register Controlled Trials inception July 2, 2024. included all randomized controlled trials testing deprescribing intervention adults (mean median age ≥ 65 years) analyzed subsample reporting as an outcome. Results Among 139 eligible identified, only 12 reported ADWE. These utilized 6 approaches capture ADWEs: Naranjo Probability Scale; monitoring specific symptoms; identification through ICD‐10 codes; subset confirmed patient/caregiver self‐report; judgment. Conclusion few there lack standardized reporting. harmonized approach criteria could ensure more consistent results trials, improve our this important outcome, facilitate future meta‐analyses.
Язык: Английский
Процитировано
1
BMJ Open, Год журнала: 2024, Номер 14(1), С. e075325 - e075325
Опубликована: Янв. 1, 2024
Objective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) appropriateness of and (3) implementation prescribing recommendations generated by electronic decision support system tested ‘Optimising PharmacoTherapy In Multimorbid Elderly Primary CAre’ (OPTICA) trial. Design A longitudinal sub-study OPTICA trial, a cluster randomised controlled Setting Swiss primary care settings. Participants were aged ≥65 years, with ≥3 chronic conditions ≥5 regular recruited from 43 general practitioner (GP) practices. Exposures Patients’ was assessed using three questions ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire its concerns about stopping score. Measures/analyses Medication-related outcomes collected at 1 year follow-up. Aim outcome: number long-term baseline 12 month 2 medication (Medication Appropriateness Index). 3 binary variable on whether any recommendation during review implemented. We used multilevel linear regression analyses (aim aim 2) logistic 3). Models adjusted for sociodemographic variables clustering effect GP level. Results 298 patients completed rPATD, 45% women 78 years median age. statistically significant found score over time (per 1-unit increase average use 0.65 higher; 95% CI: 0.08 1.22). Other than that we did not find evidence associations agreement deprescribing medication-related outcomes. Conclusions an most measures patient year. Trial registration NCT03724539 .
Язык: Английский
Процитировано
6
European Journal of Internal Medicine, Год журнала: 2023, Номер 115, С. 29 - 33
Опубликована: Июнь 28, 2023
Язык: Английский
Процитировано
15
JAMA Network Open, Год журнала: 2023, Номер 6(10), С. e2337281 - e2337281
Опубликована: Окт. 11, 2023
Little is known about why older adults decline deprescribing recommendations, primarily because interventional studies rarely capture the reasons.To examine factors important to who disagree with a recommendation given by primary care physician hypothetical patient experiencing polypharmacy.This online, vignette-based survey study was conducted from December 1, 2020, March 31, 2021, participants 65 years or in United Kingdom, US, Australia, and Netherlands. The outcome of main disagreement recommendation. A content analysis subsequently free-text reasons provided strongly disagreed deprescribing. Data were analyzed August 22, 2022, February 12, 2023.Attitudes, beliefs, fears, recommended actions response recommendations.Of 899 included analysis, mean (SD) age 71.5 (4.9) years; 456 (50.7%) men. Attitudes, fears reported doubts (361 [40.2%]), valuing medications (139 [15.5%]), preference avoid change (132 [14.7%]). Valuing more commonly among compared those (48 205 [23.4%] vs 91 694 [13.1%], respectively; P < .001) had personal experience same medication class as vignette no (93 517 [18.0%] 46 318 [12.1%], = .02). Participants shared that improved communication (225 [25.0%]), alternative strategies (138 [15.4%]), consideration preferences (137 [15.2%]) may increase their agreement interested additional (196 [28.2%] 29 [14.2%], .001), (117 [16.9%] 21 [10.2%], .02), (122 [17.6%] 15 [7.3%], .001).In this study, communication, strategies, disagreed. These findings suggest identifying degree could be used tailor patient-centered adults.
Язык: Английский
Процитировано
11
Journal of the American Medical Directors Association, Год журнала: 2024, Номер 25(7), С. 105021 - 105021
Опубликована: Май 17, 2024
Язык: Английский
Процитировано
4
Ageing Research Reviews, Год журнала: 2025, Номер 104, С. 102661 - 102661
Опубликована: Янв. 11, 2025
Efforts to reduce preventable medication-related harm through medication reviews have increased, but interventions often yield null-results regarding clinical outcomes. We conducted a systematic literature search in four data bases and summarised the available evidence from randomised controlled trials (RCTs) comparing usual care hospitalised patients hospital readmissions all-cause mortality by random-effects meta-analyses. Effect size differences methodological study were of special interest. The meta-analysis all 24 on readmissions, including 12,539 participants, showed statistically significant 8% decrease (risk ratio (RR) [95% confidence interval]: (0.92 [0.88-0.97], p=0.002). number patient contacts was most prominent effect modifier meta-regression (p=0.003) approximately twice as strong (15%) 11 with 2 or more (0.85 [0.78-0.92], p<0.001). No reduction observed 22 for this outcome (0.95 [0.86-1.04], p=0.24), 12,350 participants. method assessment identified an (p=0.01). A 10 complete ascertainment via registries primary significantly 19% reduced (0.81 [0.70-0.94], p<0.01)). In conclusion, risk readmission might also mortality. Comprehensive essential successful trials. Clinical guidelines should recommend multiple contacts, involving pharmacists, either repeated improve adherence.
Язык: Английский
Процитировано
0
Journal of the American Geriatrics Society, Год журнала: 2025, Номер unknown
Опубликована: Янв. 27, 2025
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 2023. We selected high‐quality studies that advanced field research. chosen cover domains related deprescribing/discontinuation, optimizing use, safety/adverse drug events, other. first study a randomized clinical trial evaluating efficacy patient‐centered Shed‐MEDS deprescribing intervention among adults transitioning from hospital postacute facilities (domain: deprescribing/discontinuation). second study, retrospective cohort Medicare beneficiaries, described phenomenon prescribing cascade relic evaluated continued potassium after discontinuation loop diuretic use). third systematic review meta‐analysis describing prevalence drug–drug interactions community‐dwelling other). Lastly, fourth beneficiaries concurrent gabapentin opioid risk mortality safety). Collectively, succinctly highlights pertinent topics promoting safe medications promotes awareness adults' regimens.
Язык: Английский
Процитировано
0
Опубликована: Янв. 1, 2025
Язык: Английский
Процитировано
0