Deprescribing in older adults with polypharmacy

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

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Barriers and Enablers for Deprescribing Glucose-Lowering Treatment in Older Adults: A Systematic Review

Journal of the American Medical Directors Association, Год журнала: 2024, Номер 25(3), С. 439 - 447.e18

Опубликована: Янв. 15, 2024

Язык: Английский

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Attitudes towards deprescribing and patient-related factors associated with willingness to stop medication among older patients with type 2 diabetes (T2D) in Indonesia: a cross-sectional survey study

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

Опубликована: Янв. 12, 2023

Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people type 2 diabetes (T2D). It seems that many low-middle-income countries are not willing to have their medicines deprescribed. This study aims assess attitudes Indonesian T2D towards deprescribing general and regarding specific cardiometabolic medicines, factors influencing willingness stop medicines.Primary care ≥60 years Indonesia completed the revised Patients' Attitudes Towards (rPATD) questionnaire. for were reported descriptively. Proportions one or more when by different healthcare professionals compared Chi-square test. Multiple regression analysis was used analyse influence between patient-related medicines.The survey 196 participants (median age 69 years, 73% female). The percentages 69, 67, 41%, practitioner (GP), specialist, pharmacist initiates process (p-value < 0.001). Higher perceived burden = 0.03) less concerns about stopping 0.001) associated a higher if proposed GP. Patients using multiple glucose-regulating 0.02). Using complementary alternative stop. If pharmacist, without substantial education than educated patients.Only two-thirds GP specialist this, even this. Attention should be given especially among glucose-lowering who may eligible but accept deprescribing.

Язык: Английский

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Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

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

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Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review: the LeMON study (Less Medicines in Older Patients in the Netherlands), a cluster randomized controlled trial

International Journal of Clinical Pharmacy, Год журнала: 2025, Номер unknown

Опубликована: Янв. 23, 2025

Язык: Английский

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Enablers and barriers to community pharmacists’ readiness to implement deprescribing of inappropriate medications for older adults in Qatar

PLoS ONE, Год журнала: 2025, Номер 20(1), С. e0316363 - e0316363

Опубликована: Янв. 30, 2025

There is paucity of studies focused on the enablers and barriers to community pharmacists’ readiness deprescribe inappropriate medications for older adults in developing settings. The current study assessed implement deprescribing adults. A cross-sectional survey 252 pharmacists was conducted Qatar with a pre-tested 24-item questionnaire developed theory domain framework. Information about perceived were elicited 5-point Likert-type scale. response rate 79.4% (200/252). majority females (54.5%), within age range 20–40 years (88.0%), had BSc / BPharm as highest educational qualification (70.5%), full-time employee (97.0%). top-ranked exposure CPD use toolkits algorithm (66%), interprofessional collaboration physicians (60.5%) shared electronic patient record (59.5%), improved remuneration re-imbursement 58%). lack access records ineffective (66.5%), time due heavy workload (65%), regulatory framework that limit expansion clinical roles (51%) intense focus sales target (49%). algorithm, record. These findings bode well implementation pharmacists-led Qatar. However, number critical identified, these will require institutional, organizational interventions improve readiness.

Язык: Английский

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Unlocking Deprescribing Potential in Nursing Homes: Insights from a Focus Group Study with Healthcare Professionals

Drugs & Aging, Год журнала: 2024, Номер 41(3), С. 261 - 270

Опубликована: Янв. 29, 2024

The nursing home population is characterized by multimorbidity and disabilities, which often result in extensive prescription of medication subsequent polypharmacy. Deprescribing, a planned supervised process dose reduction or total cessation medication, solution to combat this. This study aimed identify barriers enablers deprescribing as experienced physicians (NHPs) collaborating pharmacists the specific setting. qualitative utilized semi-structured interview format with two focus groups consisting mix NHPs pharmacists. Directed content analysis was performed based on Theoretical Domains Framework, validated framework for understanding determinants behavior change among health care professionals. Sixteen professionals participated groups, including 13 three participating believed that valuable enablers, such multidisciplinary collaboration, good communication patients family, involvement staff. view core task feel assured their ability carry it out successfully. However, they also noted barriers: time-consuming; residents, relatives medical specialists difficult; electronic patient systems do not adequately support it. provides insight into various faced when homes. Specific this population, (with residents relatives, specialists) resources, while knowledge expertise are mentioned enablers.

Язык: Английский

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Mobile applications on app stores for deprescribing: A scoping review

British Journal of Clinical Pharmacology, Год журнала: 2024, Номер unknown

Опубликована: Авг. 4, 2024

Abstract Deprescribing is an evidence‐based intervention to reduce potentially inappropriate medication use. Yet its implementation faces barriers including inadequate resources, training and time. Mobile applications (apps) on app stores could address some by offering educational content interactive features for assessment deprescribing guidance. A scoping review was undertaken examine existing apps, identifying artificial intelligence (AI) elements. comprehensive search conducted in August 2023 identify mobile apps with within the Apple Google Play Stores. The found were screened inclusion, data their extracted. Quality using App Rating Scale. Six deprescribing‐related identified: American Geriatrics Society Beers Criteria 2023, Dementia Training Australia Medications, Evidence‐Based Medicine Guide, Information Assessment Method Medical Guidelines, MedGPT‐Medical AI App, Polypharmacy: Manage Medicines. These focused primarily educating both patients/carers healthcare professionals about deprescribing. Amongst them, two included features, one incorporating technology. While these allowed queries input of patient‐level details, provided limited personalised advice. In terms quality, scored highly functionality information, poorly engagement aesthetics. This despite being educational, have limitations personalization user engagement. Future research should prioritize evaluating feasibility experience clinical settings, further explore how interactivity enhance usefulness practices.

Язык: Английский

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Process evaluation of a pharmacist‐led intervention aimed at deprescribing and appropriate use of cardiometabolic medication among adult people with type 2 diabetes

Basic & Clinical Pharmacology & Toxicology, Год журнала: 2023, Номер 134(1), С. 83 - 96

Опубликована: Авг. 11, 2023

A quasi-experimental study investigated a pharmacist-led intervention aimed at deprescribing and medication management among adult patients with type 2 diabetes risk of hypoglycaemia.This to evaluate the process implementing consisting tailored clinical review (CMR) supported by training toolbox.Mixed-methods based on Grant framework, including domains "recruitment," "delivery intervention" "response" pharmacists patients. Data collected were administrative logs, semi-structured observations patient consultations (n = 8), interviews 16) patient-reported experience measure (PREM) questionnaires 66).Tailored CMRs conducted largely as intended for 90 from 14 pharmacies. Although selection medication-derived hypoglycaemia score was considered useful, experienced barriers proposing in recent changes, without current hypoglycaemic events, or treated medical specialists. The toolbox evaluated positively pharmacists. Overall, satisfied CMR.Pharmacists valued CMR focusing management. To optimize implementation effectiveness intervention, improvements can be made selection, pharmacist collaboration between healthcare professionals.

Язык: Английский

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How to Deprescribe Potentially Inappropriate Medications During the Hospital-to-Home Transition: Stakeholder Perspectives on Essential Tasks

Clinical Therapeutics, Год журнала: 2023, Номер 45(10), С. 947 - 956

Опубликована: Авг. 26, 2023

Язык: Английский

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