Consumer Attitudes Towards Deprescribing: A Systematic Review and Meta-Analysis

The Journals of Gerontology Series A, Год журнала: 2021, Номер 77(5), С. 1020 - 1034

Опубликована: Авг. 14, 2021

Abstract Background Harmful and/or unnecessary medication use in older adults is common. This indicates deprescribing (supervised withdrawal of inappropriate medicines) not happening as often it should. study aimed to synthesize the results Patients’ Attitudes Towards Deprescribing (PATD) questionnaire (and revised versions). Methods Databases were searched from January 2013 March 2020. Google Scholar was used for citation searching development and validation manuscripts identify original research using validated PATD, PATD (older adult caregiver versions), version people with cognitive impairment (rPATDcog). Two authors extracted data independently. A meta-analysis proportions (random-effects model) conducted subgroup meta-analyses setting population. The primary outcome question: “If my doctor said possible, I would be willing stop one or more medicines.” Secondary outcomes associations between participant characteristics other (r)PATD results. Results We included 46 articles describing 40 studies (n = 10,816 participants). found proportion participants who agreed strongly this statement 84% (95% CI 81%–88%) 80% 74%–86%) patients caregivers, respectively, significant heterogeneity (I2 95% 77%). Conclusion Consumers reported willingness have a deprescribed although should interpreted caution due heterogeneity. findings moves toward understanding attitudes deprescribing, which could increase discussion uptake recommendations clinical practice.

Язык: Английский

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How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing?

Journal of Clinical Pharmacy and Therapeutics, Год журнала: 2018, Номер 43(4), С. 550 - 555

Опубликована: Апрель 22, 2018

What is known and objective Deprescribing the process of discontinuing or reducing dosage medications that are no longer appropriate aligned with goals care, which paramount in elderly patients multiple comorbidities polypharmacy. The this study was to assess perceptions primary care physicians on deprescribing for potential barriers experience Local Health Authority (LHA) Parma, Emilia-Romagna, Italy. Methods One hundred sixty (57% total number Parma) attended an educational session related were asked anonymously complete a paper survey. Participants their level agreement nine questions about perception factors affecting using seven-point Likert-type scale. A correlation coefficient calculated association between physicians' confidence attitudes associated deprescribing. Results discussion Many (72%) reported general ability deprescribe. Most respondents (78%) they comfortable preventive medications, yet only half (53%) guideline-recommended therapies. Lack evidence medicines concern withdrawal side effects impede by more than one-third physicians. When initially prescribed another physician, 40% hesitance them. About (45%) did not feel when patients/caregivers believed continuation medication needed. time difficulty engaging cited as one four There strong new conclusion results show believe generally deprescribing, although there still several hamper engage process. An improved understanding views may help guide further research, policies remain healthy while streamlining regimen.

Язык: Английский

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Managing greenhouse gas emissions in the terminal year of life in an overwhelmed health system: a paradigm shift for people and our planet

The Lancet Planetary Health, Год журнала: 2024, Номер 8(5), С. e327 - e333

Опубликована: Май 1, 2024

Health care contributes 4·4% of global net carbon emissions. Hospitals are resource-intensive settings, using a large amount supplies in patient and have high energy, ventilation, heating needs. This Viewpoint investigates emissions related to health patient's last year life. End life (EOL) is period when health-care use associated production increases exponentially due primarily hospital admissions, which often at odds with patients' values preferences. Potential solutions detailed within this facilitating advanced plans patients ensure their EOL wishes clear, beginning palliative interventions earlier treating life-limiting illness, deprescribing unnecessary medications because supply chains make up significant portion emissions, and, enhancing access low-intensity community settings (eg, hospices) the if home not available. Our analysis was done Canadian data, but findings can be applied other high-income countries.

Язык: Английский

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Use and Deprescribing of Potentially Inappropriate Medications in Frail Nursing Home Residents

Drugs & Aging, Год журнала: 2020, Номер 37(12), С. 917 - 924

Опубликована: Окт. 13, 2020

Язык: Английский

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Deprescribing research in nursing home residents using routinely collected healthcare data: a conceptual framework

BMC Geriatrics, Год журнала: 2023, Номер 23(1)

Опубликована: Авг. 4, 2023

Abstract Background Efforts are needed to strengthen evidence and guidance for appropriate deprescribing older nursing home (NH) residents, who disproportionately affected by polypharmacy inappropriate prescribing. Given the challenges of conducting randomized drug withdrawal studies in this population, data from observational routinely collected healthcare can be used identify patients apparent candidates evaluate subsequent health outcomes. To improve design interpretation examining determinants, risks, benefits specific medications NH we sought propose a conceptual framework determinants residents. Methods We conducted scoping review patterns potential discontinuing or de-intensifying (i.e., reducing) searched PubMed through September 2021 included meeting following criteria: among adults aged 65 + setting; (2) study designs; (3) discontinuation de-intensification as primary outcome with key independent variables. conceptualized behavior social-ecological lens, potentially influenced factors at intrapersonal, interpersonal, organizational, community, policy levels. Results Our search identified 250 relevant published 2021. A total 14 were inclusion subsequently synthesized group into domains spanning five core resulting acknowledges that is strongly patient-level clinical modify expected risks deprescribing, including index condition attributes (e.g., disease severity), medication being considered co-prescribed medications, prognostic factors. It also incorporates hierarchical influences interpersonal differences relating providers family caregivers, facility system organizational structures, community trends norms, finally policies. Conclusions proposed will serve useful tool future seeking use sources designs

Язык: Английский

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Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study

European Journal of Clinical Pharmacology, Год журнала: 2022, Номер 78(10), С. 1633 - 1646

Опубликована: Июль 27, 2022

Язык: Английский

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Prevalence of potentially inappropriate medications based on the STOPPFrail criteria in frail older patients with limited life expectancy: a cross-sectional study

BMC Geriatrics, Год журнала: 2022, Номер 22(1)

Опубликована: Апрель 27, 2022

Abstract Background The recently developed Screening Tool of Older Persons' Prescriptions in Frail adults with a limited life expectancy (STOPPFrail) criteria can be helpful for screening medications (PIMs), but it is yet to widely used clinical practice. Herein, we aimed investigate the prevalence PIMs based on STOPPFrail (STOPPFrail-PIM) among frail older admitted geriatric center. Methods This was retrospective cross-sectional study conducted center at an academic tertiary care hospital Korea. We evaluated who received comprehensive assessment (CGA) between 1 January, 2019 and 30 June, 2020. were identified by geriatricians records STOPPFrail-PIMs analysed trained pharmacists. Descriptive analysis, t-test, chi-square test using IBM SPSS software version 25.0. Results Among 504 underwent CGA after admission, 171 included study. An average 11.3 ± 4.7 administered regularly each patient before admission. Overall, 97.1% (166/171) had least one STOPPFrail-PIM, mean number STOPPFrail-PIM 4.2 2.8. Drugs without clear indication (A2) most frequent pre-admission followed lipid-lowering therapies (B1) neuroleptic antipsychotics (D1). significantly lower discharge than that decrease being highest A2 94.7%. Conclusions Most rate decreased multidisciplinary team care. Further studies are needed association use adverse consequences adults.

Язык: Английский

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Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life

Current Epidemiology Reports, Год журнала: 2021, Номер 8(3), С. 116 - 129

Опубликована: Апрель 23, 2021

Abstract Purpose of Review To describe approaches to measuring deprescribing and associated outcomes in studies patients approaching end life (EOL). Recent Findings We reviewed published through 2020 that evaluated with limited expectancy EOL. Deprescribing includes reducing the number medications, decreasing medication dose(s), eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary selection should align operationalized definition used by study investigators. Summary EOL considerations include appropriateness context patient goals for care, expected benefit from given expectancy, heightened potential medication-related harm death nears. Additional data are needed on how impacts quality life, caregiver burden, out-of-pocket costs caregivers. Investigators design this information mind.

Язык: Английский

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Validated medication deprescribing instruments for patients with palliative care needs: a systematic review

Farmacia Hospitalaria, Год журнала: 2023, Номер 48(2), С. 83 - 89

Опубликована: Сен. 26, 2023

Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute minimizing negative outcomes. Thus, the aims of study were identify validated instruments for deprescribing inappropriate medications patients palliative care needs and assess impact on clinical, humanistic, economic

Язык: Английский

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Considerations for systematic reviews of quantitative surveys: Learnings from a systematic review of the Patients’ Attitudes Towards Deprescribing questionnaire

Research in Social and Administrative Pharmacy, Год журнала: 2021, Номер 18(2), С. 2345 - 2349

Опубликована: Июль 30, 2021

Язык: Английский

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