Research Square (Research Square),
Год журнала:
2021,
Номер
unknown
Опубликована: Ноя. 12, 2021
Abstract
Background:
The
effectiveness
of
psychotropic
medication
on
behavioral
and
psychological
symptoms
in
dementia
(BPSD)
is
limited,
while
associated
with
a
higher
risk
adverse
events.
Non-pharmacological
treatment
BPSD
advocated
as
first
choice.
However,
many
general
practitioners
(GPs)
find
it
difficult
to
initiate
deprescribing
when
attempting
discontinue
nursing
home
residents,
they
face
barriers.
Therefore,
we
hypothesize
that
an
intervention
aimed
at
improving
communication
involvement
staff,
relatives,
patients
by
GPs
can
optimize
the
pharmacological
BPSD.
aim
reduce
use
antidepressants
residents
without
increasing
morbidity
or
mortality.
Objective:
primary
outcome
reduction
antidepressant.
Secondary
outcomes
include
difference
other
medication,
mortality,
morbidity,
severity
Method:
study
cluster-randomized
controlled
trial
based
practices
Denmark.
We
22
practices,
each
which
will
recruit
up
15
living
homes.
period
three
months,
total
one
year.
Randomization
1:1
control
group
computer
algorithm.
Both
groups
receive
education
its
evidence-based
treatment.
includes
tailored
components;
1)
teaching
material
training
be
used
GP
educate
staff
BPSD,
2)
pre-visit
reflection
tool
encourage
evaluate
reflect
relatives
discontinuation
process
3)
dialogue
facilitate
shared
decision
making
optimization
during
visits
home.
enhanced
care
usual.
secondary
assessed
end
period.
An
evaluation
conducted
assess
implementability.
Discussion:
anticipate
for
homes
enhance
compliance
medication.
should
provide
insights
into
barriers
facilitators
changing
current
practice
deprescribing.
Trial
registration:
Clinicaltrials.gov:
NCT04985305.
Registered
30
July
2021.
https://clinicaltrials.gov/ct2/show/NCT04985305
Scandinavian Journal of Primary Health Care,
Год журнала:
2025,
Номер
unknown, С. 1 - 10
Опубликована: Март 12, 2025
Background
Obesity
is
a
complex
condition
and
recognized
public
health
challenge.
Previous
treatment
options
were
associated
with
high
failure
rates,
but
recent
trials
have
shown
that
significant
weight
loss
can
be
achieved
GLP1-RAs.
However,
little
known
about
the
patient's
experiences
Ars Pharmaceutica (Internet),
Год журнала:
2025,
Номер
66(2), С. 233 - 246
Опубликована: Март 19, 2025
Objective:
To
synthesize
the
available
evidence
on
antipsychotic
gradual
dose
reduction
or
abrupt
deprescription
in
older
people
population
with
dementia.
Methods:
A
systematic
review
of
intervention
studies.
PubMed,
Embase,
Web
Science-Core
Collection,
Cochrane
Library,
Scopus,
MEDLINE(Ovid),
and
PsycINFO
databases
were
consulted.
Articles
eligible
for
inclusion
if
they
studies
(randomized
quasi-experimental
trials)
evaluating
effectiveness
complete
withdrawal
deprescribing
strategies
The
screening
process,
data
extraction,
analysis
bias
risk
assessment
performed
by
two
independent
reviewers
any
discrepancies
triangulated
a
third
reviewer.
Results:
Eight
clinical
trials
ultimately
included
review,
which
quasi
experimental.
Over
60%
participants
came
from
nursing
care
homes.
There
is
several
antipsychotics.
Five
used
an
schedule
three
reduction.
Deprescription
through
schedules
showed
no
significant
differences
management
behavioral
symptoms,
although
withdrawals
significantly
higher
rates
relapse
and/or
adverse
events.
Conclusion:
Deprescribing
antipsychotics
feasible
those
dementia,
it
associated
benefits
terms
survival,
potential
improved
outcomes
psychological
symptoms
It
seems
reasonable
that
tapering
off
medication
should
be
assessed
after
12
weeks
treatment
when
behavioural
are
under
control.
International Journal of Geriatric Psychiatry,
Год журнала:
2024,
Номер
39(5)
Опубликована: Апрель 27, 2024
Abstract
Objectives
Dementia
guidelines
recommend
antipsychotics
are
only
used
for
behavioral
and
psychological
symptoms
when
non‐drug
interventions
fail,
to
regularly
review
use.
Population‐level
clinical
quality
indicators
(CQIs)
dementia
care
in
permanent
residential
aged
(PRAC)
typically
monitor
prevalence
of
antipsychotic
use
but
not
prolonged
This
study
aimed
develop
a
CQI
>90
days
examine
trends,
associated
factors,
variation
incidence;
duration
the
first
episode
among
individuals
with
accessing
home
packages
(HCPs)
or
PRAC.
Methods
Retrospective
cohort
study,
including
older
who
accessed
HCPs
(
n
=
50,257)
PRAC
250,196).
Trends
annual
incidence
(2011–12
2015–16)
factors
were
determined
using
Poisson
regression.
Funnel
plots
examined
geographical
facility
variation.
Time
discontinuation
was
estimated
new
users
HCP
2367)
15,597)
cumulative
function.
Results
Between
2011–12
2015–16,
decreased
recipients
from
10.7%
(95%
CI
10.2–11.1)
10.1%
9.6–10.5,
adjusted
rate
ratio
(aIRR)
0.97
0.95–0.98)),
residents
24.5%
24.2–24.7)
21.8%
21.5–22.0,
aIRR
0.96–0.98)).
Prior
(both
cohorts)
being
male
greater
socioeconomic
disadvantage
(PRAC
cohort)
higher
incidence.
Little
geographical/facility
observed.
Median
treatment
334
(interquartile
range
[IQR]
108–958)
555
(IQR
197–1239)
days,
respectively.
Conclusions
While
small
decreases
observed
between
findings
suggest
can
be
further
minimized.
Basic & Clinical Pharmacology & Toxicology,
Год журнала:
2023,
Номер
134(1), С. 97 - 106
Опубликована: Окт. 12, 2023
Understanding
the
patient
perspective
is
a
significant
part
of
deprescribing
process.
This
study
aimed
to
explore
attitudes
older
patients
with
psychiatric
disorders
towards
deprescribing.
A
total
72
outpatients
(68%
women;
median
age
76
years)
completed
validated
Danish
version
revised
Patients'
Attitudes
Towards
Deprescribing
(rPATD)
questionnaire.
Patients
used
eight
medications
(interquartile
range
6-12),
88%,
49%
and
24%
using
antidepressants,
antipsychotics
anxiolytics,
respectively.
Fifty-one
percent
reported
an
intrinsic
desire
stop
one
their
medications,
while
92%
would
be
willing
on
physician's
advice.
Seventy-five
worried
about
missing
out
future
benefits
following
37%
had
previous
bad
experiences.
Use
≥8
regular
was
associated
more
concerns
stopping
medication
greater
perceived
burden
medication,
use
not
any
differences
in
rPATD
factor
scores.
It
crucial
for
health
care
professionals
aware
patients'
specific
past
experiences
promote
patient-centred
approach
that
takes
into
account
needs
preferences
disorders.
Exploratory Research in Clinical and Social Pharmacy,
Год журнала:
2024,
Номер
14, С. 100446 - 100446
Опубликована: Апрель 21, 2024
Antipsychotics
are
commonly
administered
to
nursing
home
residents
with
dementia,
despite
the
associated
risk
of
severe
adverse
events.
This
study
aimed
explore
healthcare
professionals'
experiences
in
caring
for
a
focus
on
rationales
behind
use
antipsychotics.
Twelve
semi-structured
interviews
from
Danish
homes
were
conducted
and
analyzed
using
method
Systematic
Text
Condensation.
Nonpharmacological
interventions
reported
as
primary
approach
care
first-choice
treatment
behavioral
psychological
symptoms
dementia
(BPSD).
Use
antipsychotics
was
considered
serve
last
resort,
reserved
symptoms.
However,
most
informants
preferred
more
limited
use.
The
identified
four
main
barriers
reduce
antipsychotics:
"Scarcity
resources",
"Perceiving
antipsychotic
provide
relieve",
"Reluctance
towards
deprescribing"
"Limited
access
medical
counseling",
three
potential
enablers:
"Updating
knowledge
nonpharmacological
competencies",
"Management
support
clear
procedures"
"Regularity
interdisciplinary
collaboration".
primarily
following
guidelines
BPSD.
Several
perceived
challenge
preference
To
further
use,
this
highlights
importance
understanding
effects
caused
by
resources,
enhancing
employee
competencies
ensuring
regular
interprofessional
collaboration
assessing
reassessing
need
Abstract
Background
Despite
recommendations
against
psychotropic
medication
in
older
nursing
homes
residents
with
behavioral
and
psychological
symptoms
of
dementia
(BPSD),
antidepressants
other
drugs
are
still
prescribed.
We
performed
a
cluster-randomized
controlled
trial
to
evaluate
the
effect
complex
intervention
aiming
promote
deprescribing
institutionalized
persons
dementia.
To
understand
underlying
mechanisms
outcomes,
we
conducted
process
evaluation
exploring
interventions
implementation,
areas
impact,
contextual
factors.
The
aim
this
study
was
explore
implementation
key
factors
that
promoted
inhibited
care
home
setting
(Clinicaltrials.gov:
NCT04985305.
Registered
30
July
2021).
Methods
Qualitative
interviews
were
between
August
2022
February
2023
four
general
practitioners
eight
staff
from
associated
Capital
Region
Denmark.
coded
interview
data
according
constructs
Normalization
Process
Theory
(coherence,
cognitive
participation,
collective
action,
reflexive
monitoring).
Results
There
common
understanding
aim.
observed
raised
awareness
concerning
deprescription
among
healthcare
professionals
good
collaboration
(coherence).
An
overall
buy-in
mentality
seen
(cognitive
participation).
barriers
GPs
staff’s
use
elements
how
they
implemented
it,
but
some,
language
created
(collective
action).
Professionals
valued
idea
deprescribing,
lack
time,
high
turnover,
low
education
level
hampered
integration
(reflexive
Conclusion
Successful
seemed
be
dependent
on
quality
relationship
single
GP
professional.
A
uptake
intervention.
However,
several
related
resources
hindered
implementation.
It
is
imperative
adapt
available
context.
Acta Pharmaceutica,
Год журнала:
2024,
Номер
74(2), С. 249 - 267
Опубликована: Май 30, 2024
Abstract
This
umbrella
review
examined
systematic
reviews
of
deprescribing
studies
by
characteristics
intervention,
population,
medicine,
and
setting.
Clinical
humanistic
outcomes,
barriers
facilitators,
tools
for
are
presented.
The
Medline
database
was
used.
search
limited
to
meta-analyses
published
in
English
up
April
2022.
Reviews
reporting
were
included,
while
those
where
depre-scribing
not
planned
supervised
a
healthcare
professional
excluded.
A
total
94
(23
meta--analyses)
included.
Most
explored
clinical
or
outcomes
(70/94,
74
%);
less
attitudes,
(17/94,
18
few
focused
on
(8/94,
8.5
%).
assessing
divided
into
two
groups:
with
intervention
trials
(39/70,
56
%;
16
reviewing
specific
interventions
23
broad
medication
optimisation
interventions),
cessation
(31/70,
44
Deprescribing
feasible
resulted
reduction
inappropriate
medications
.
Complex
shown
reduce
hospitalisation,
falls,
mortality
rates.
In
trials,
higher
frequency
adverse
drug
withdrawal
events
underscores
the
importance
prioritizing
patient
safety
exercising
caution
when
stopping
medicines,
particularly
patients
clear
appropriate
indications.
