Swimming Against the Tide: Primary Care Physicians’ Views on Deprescribing in Everyday Practice

The Annals of Family Medicine, Год журнала: 2017, Номер 15(4), С. 341 - 346

Опубликована: Июль 1, 2017

PURPOSE

Avoidable hospitalizations due to adverse drug events and high-risk prescribing are common in older people. Primary care physicians prescribe most on-going medicines. Deprescribing has long been essential best practice. We sought explore the views of primary on barriers facilitators deprescribing everyday practice inform development an intervention support safer prescribing.

METHODS

used a snowball sampling technique identify potential participants. Physicians were selected basis years practice, employment status, setting, with additional focus information-rich Twenty-four semistructured interviews audio-recorded, transcribed verbatim, analyzed emergent themes.

RESULTS

described as "swimming against tide" patient expectations, medical culture prescribing, organizational constraints. They said came inherent risks for both themselves patients conveyed sense vulnerability The only incentive they identified was duty do what right patient. recommended changes including targeted funding annual medicines review, computer prompts, improved information flows between prescribers, access expert advice user-friendly decision support, increased availability non-pharmaceutical therapies, enhanced engagement management.

CONCLUSIONS

Interventions should consider sociocultural, personal, relational, constraints deprescribing. Regulations policies be designed practicing according their professional ethical values.

Язык: Английский

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Theory-Based Interventions to Improve Medication Adherence in Older Adults Prescribed Polypharmacy: A Systematic Review

Drugs & Aging, Год журнала: 2016, Номер 34(2), С. 97 - 113

Опубликована: Дек. 26, 2016

Previous interventions have shown limited success in improving medication adherence older adults, and this may be due to the lack of a theoretical underpinning. This review sought determine effectiveness theory-based aimed at adults prescribed polypharmacy explore extent which psychological theory informed their development. Eight electronic databases were searched from inception March 2015, extensive hand-searching was conducted. Interventions delivered (populations with mean/median age ≥65 years) (four or more regular oral/non-oral medicines) eligible. Studies had report an underpinning measure least one clinical/humanistic outcome. Data extracted independently by two reviewers included details intervention content, delivery, providers, participants, outcomes theories used. The coding scheme (TCS) used assess use. Five studies cited as basis for development (social cognitive theory, health belief model, transtheoretical self-regulation model). use terms varied across studies. No study made optimal recommended TCS. heterogeneity observed inclusion pilot designs mean conclusions regarding targeting could not drawn. Further primary research involving central component is required. findings will help inform design future interventions.

Язык: Английский

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Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community‐dwelling older people: a prospective cohort study

British Journal of Clinical Pharmacology, Год журнала: 2016, Номер 82(3), С. 849 - 857

Опубликована: Май 2, 2016

Aims This study aims to determine if potentially inappropriate prescribing (PIP) is associated with increased healthcare utilization, functional decline and reduced quality of life (QoL) in a community‐dwelling older cohort. Method prospective cohort included participants aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) linked administrative pharmacy claims data who were followed up after 2 years. PIP was defined by the Screening Tool for Older Persons Prescriptions (STOPP) Alert doctors Right Treatment (START). association number emergency department (ED) visits GP reported over 12 months analyzed using multivariate negative binomial regression adjusting confounders. Marginal structural models investigated presence time‐dependent confounding. Results Of ( n = 1753), detected 57% STOPP 41.8% START, 21.7% an ED visit 96.1% visited (median 4, IQR 2.5–6). Those any criterion had higher rates (adjusted incident rate ratio (IRR) 1.30, 95% confidence interval (CI) 1.02, 1.66) (IRR 1.15, 95%CI 1.06, 1.24). Patients two or more START criteria significantly 1.45, 1.03, 2.04) 1.13, 1.01, 1.27) than people no criteria. Adjusting confounding did not affect findings. Conclusions Both independently utilization also related QoL. Optimizing reduce may provide improvement patient outcomes.

Язык: Английский

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Optimizing pharmacotherapy in elderly patients: the role of pharmacists

Integrated Pharmacy Research and Practice, Год журнала: 2015, Номер unknown, С. 101 - 101

Опубликована: Авг. 1, 2015

Abstract: As the world's population ages, global health care systems will face burden of chronic diseases and polypharmacy use among older adults. The traditional tasks medication dispensing provision basic education by pharmacists have evolved to active engagement in direct patient collaborative team-based care. patients is an especially fitting mission for pharmacists, since key geriatric often lies with management use, preventing harmful consequences both. Because most conditions are treated medications, their extensive training pharmacotherapy pharmacokinetics, a unique critical position them. Pharmacists expertise detect, resolve, prevent errors drug-related problems, such as overtreatment, undertreatment, adverse drug events, nonadherence. also competent critically reviewing applying clinical guidelines individual patients, some instances confront lack data (common adults) provide best possible patient-centered current review aimed depict evidence pharmacy care, demonstrate impact pharmacists' interventions on survey tools used effective explore role optimization elders. findings strongly support previous studies that showed positive patients' health-related outcomes. There clear working directly or collaboratively improve populations. Therefore, systems, teams caring elders should involve optimize pharmacotherapy. Keywords: pharmacist, elderly, adult, pharmacotherapy, medication,

Язык: Английский

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Intervention to Improve Appropriate Prescribing and Reduce Polypharmacy in Elderly Patients Admitted to an Internal Medicine Unit

PLoS ONE, Год журнала: 2016, Номер 11(11), С. e0166359 - e0166359

Опубликована: Ноя. 30, 2016

Polypharmacy and inappropriate medication prescriptions are associated with increased morbidity mortality. Most interventions proposed to improve appropriate prescribing time resource intensive therefore hardly applicable in daily clinical practice.To test the efficacy of an easy-to-use checklist aimed at supporting therapeutic reasoning physicians order reduce polypharmacy.We assessed safety a 5-point be used by all on internal medicine wards Swiss hospital comparing outcomes 450 consecutive patients aged ≥65 years hospitalized after introduction checklist, before checklist. The main measures were proportion prescription potentially medications (PIMs) discharge, according STOPP criteria, number prescribed Secondary prevalence polypharmacy (≥ 5 drugs) hyperpolypharmacy 10 drugs), omissions (PPOs) START criteria.At admission 59% 900 taking > drugs, 13% ≥ 37% had 1 PIM 25% PPO. was significant reduction 22% risk being discharge (adjusted ratios [RR] 0.78; 95% CI: 0.68-0.94), but not least 20% drugs nor PPOs discharge.The significantly reduced discharge.

Язык: Английский

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National Use of Safety-Net Clinics for Primary Care among Adults with Non-Medicaid Insurance in the United States

PLoS ONE, Год журнала: 2016, Номер 11(3), С. e0151610 - e0151610

Опубликована: Март 30, 2016

Objective To describe the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare). Methods Cross-sectional analysis using 2006–2010 National Ambulatory Medical Care Surveys, annual probability samples outpatient visits in U.S. We estimated national prevalence weighted percentages to account complex survey design. conducted bivariate multivariate logistic regression analyses examine characteristics associated clinic use. Results More than one-third (35.0%) all were insurance, representing 6,642,000 nationally. The strongest were: being from a high-poverty neighborhood (AOR 9.53, 95% CI 4.65–19.53), dually eligible Medicare Medicaid 2.13, 1.38–3.30), black 1.97, 1.06–3.66) Hispanic 2.28, 1.32–3.93). Compared non-safety-net users, who used clinics had higher diabetes (23.5% vs. 15.0%, p<0.001), hypertension (49.4% 36.0%, multimorbidity (≥2 chronic conditions; 53.5% 40.9%, p<0.001) polypharmacy (≥4 medications; 48.8% 34.0%, p<0.001). Nearly (28.9%) beneficiaries dual eligibles, compared only 6.8% (p<0.001). Conclusions Safety net are important delivery sites minority low-income populations high burden illness. critical role is likely persist despite expanded coverage under Affordable Act.

Язык: Английский

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Medication-related quality of life among Ethiopian elderly patients with polypharmacy: A cross-sectional study in an Ethiopia university hospital

PLoS ONE, Год журнала: 2019, Номер 14(3), С. e0214191 - e0214191

Опубликована: Март 28, 2019

Polypharmacy among older patients has been associated with a decline in their quality of life. We aimed to assess the medication-related life (MRQOL) polypharmacy at Gondar University Hospital, Gondar, Ethiopia. A prospective cross-sectional study was carried out 150 elder who had visited internal medicine ward and ambulatory referral hospital from March 25 May 15, 2017, using validated scale, Medication-Related Quality Life Scale version 1.0 (MRQoLS-v1.0). total participated mean age 70.06±5.12, andtwo-thirds participants (67.3%) were female. The overall prevalence poor due current found be three fourth (75.3%) participants. Regarding severity impairment MRQoL, Univariate analysis revealed that frequency visits (COR = 1.34, 95% CI, 1.02–1.77) medication number 1.94, 1.33, 2.8) statistically significant positive association likelihood having severe impairment.The multivariate also showed one unit increase (AOR 1.45, 1.040–2.024) medications greater than 5 1.91, 1.29, 2.84) increases 1.45 1.91 times likely hood posing respectively. As far as MRQoL is concerned, did not show any between MRQoL;and Sociodemographic clinical data patients. QoL very high this study. Deprescribing should sought by health care providers optimize drug therapy minimize related

Язык: Английский

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Interventions to address polypharmacy in older adults living with multimorbidity

Canadian Family Physician, Год журнала: 2022, Номер 68(7), С. e215 - e226

Опубликована: Июль 1, 2022

Objective

To summarize evidence from published systematic reviews evaluating the effect of polypharmacy interventions on clinical and intermediate outcomes. It also summarizes adverse events that may occur as a result these interventions.

Data sources

A literature search was conducted using electronic databases MEDLINE, Embase, CINAHL, Cochrane Central, Database Systematic Reviews (PROSPERO registration number: CRD42018085767).

Study selection

The yielded total 21,329 citations, which 619 were reviewed full text 5 met selection criteria.

Synthesis

found to produce statistically significant reductions in potentially inappropriate prescribing improved medication adherence; however, observed effects outcomes inconsistent. None included reported any benefit for quality-of-life Specific health care utilization cost, reduced resource usage expenditure. no differences drug between usual groups. overall certainty low very across reviews.

Conclusion

Polypharmacy are associated with improvements adherence. However, there is limited their effectiveness

Язык: Английский

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Association of Healthy Lifestyle and Incident Polypharmacy

The American Journal of Medicine, Год журнала: 2024, Номер 137(5), С. 433 - 441.e2

Опубликована: Янв. 3, 2024

BackgroundPolypharmacy, commonly defined as taking ≥5 medications, is an undesirable state associated with lower quality of life. Strategies to prevent polypharmacy may be important priority for patients. We sought examine the association healthy lifestyle, a modifiable risk factor, incident polypharmacy.MethodsWe performed secondary analysis REasons Geographic and Racial Differences in Stroke (REGARDS) cohort study, including 15,478 adults aged ≥45 years without at baseline. The primary exposure was lifestyle baseline measured by Healthy Behavior Score (HBS), cumulative assessment diet, exercise frequency, tobacco smoking, sedentary time. HBS ranges from 0-8, whereby 0-2 indicates low HBS, 3-5 moderate 6-8 high HBS. used multinomial logistic regression between polypharmacy, survival death.ResultsHigher (i.e., healthier lifestyle) inversely after adjusting sociodemographic health variables. Compared participants those had odds (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.73-0.98) dying (OR 0.74; CI, 0.65-0.83). Participants even both 0.75; 0.64-0.88) death 0.62; 0.54-0.70). There interaction age, where most pronounced ≤65 years.ConclusionsHealthier polypharmacy.

Язык: Английский

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Economic cost-benefit analysis of person-centred medicines reviews by general practice pharmacists

International Journal of Clinical Pharmacy, Год журнала: 2024, Номер 46(4), С. 957 - 965

Опубликована: Май 30, 2024

Medicines reviews by general practice pharmacists improve patient outcomes, but little is known about the associated economic particularly in patients at higher risk of medicines-related harm. To conduct an cost-benefit analysis providing person-centred medicines to with hyperpolypharmacy (prescribed ≥ 10 regular medicines) and/or high harm across multiple settings. Service delivery costs were calculated based on pharmacist's salary, recorded timings, and a practitioner fee. Direct cost savings from change patients' post review, projected over 1 year. Indirect using two models, population-based model for avoidance hospital admissions due adverse drug reactions intervention-based applying probability reaction avoidance. Sensitivity analyses performed varying workday scenarios. Based 1471 (88.4% hyperpolypharmacy), service was €153 per review. Using model, net ranging €198 €288 review €73,317 €177,696 annum pharmacist calculated. €651-€741 corresponding annual €240,870-€457,197 pharmacist, Savings ratios ranged 181 584% all models inputs. Person-centred result substantial savings. Wider investment will be beneficial minimise both healthcare system expenditure.

Язык: Английский

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