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

---

Community‐based pharmacists' role in deprescribing: A systematic review

British Journal of Clinical Pharmacology, Год журнала: 2021, Номер 88(2), С. 452 - 463

Опубликована: Июнь 22, 2021

Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding. The aim of this study to examine the literature exploring community-based pharmacist-initiated and/or -led deprescribing evaluate impact on success clinical outcomes.Library trials databases were searched from inception March 2020. Studies included if they explored adults, by available English. Two reviewers extracted data independently using a pre-agreed extraction template. Meta-analysis was not performed due heterogeneity designs, types intervention outcomes.A total 24 studies review. Results grouped based method into four categories: educational interventions; interventions involving medication review, consultation or therapy management; pre-defined pharmacist-led collaborative interventions. All resulted greater discontinuation medications comparison usual care. Educational reported financial benefits as well. Medication review pharmacist can lead successful high-risk medication, but do affect risk rate falls, hospitalisations, mortality quality life. Pharmacist-led patients with mental illness, resulting improves anticholinergic side effects, memory Pre-defined did reduce healthcare resource consumptions contribute savings. Short follow-up periods prevent evaluation long-term sustainability interventions.This systematic suggests that valuable partners collaborations, necessary monitoring throughout tapering post-follow-up ensure intervention.

Язык: Английский

---

Deprescribing in Australian residential aged care facilities: A scoping review

Australasian Journal on Ageing, Год журнала: 2025, Номер 44(1)

Опубликована: Фев. 22, 2025

Abstract Objectives Older adults residing in residential aged care facilities (RACFs) are particularly vulnerable to negative health outcomes from polypharmacy and suboptimal prescribing the context of frailty multimorbidity. Deprescribing, intentional withdrawal inappropriate medications, has been proposed as a promising approach reduce polypharmacy‐related harms. Examining current deprescribing interventions RACFs would help identify gaps research knowledge. The aim this scoping review was synthesise literature, describe knowledge future priorities that authors identified. Methods MEDLINE, Embase, CINAHL, PsycINFO AgeLine were searched according Joanna Briggs Institute (JBI) guidelines for reviews inception until February 2024 relevant studies published English language. Results Of 2244 articles screened, 13 (total 133,150 RACF residents across Australia) identified examining interventions. Six controlled trials seven observational studies. There six pharmacist‐led interventions, five multidisciplinary team‐led two physician‐led Main themes discussed included follows: care, education health‐care professionals, refining outcome measures, overcoming system issues logistics. most commonly targeted medications psychotropics. Conclusions Deprescribing is an important intervention but more into translating evidence clinically meaningful needed. Successful typically involved had educational component, followed‐up longitudinally with carers stakeholders, such nurses. economic impacts cohort poorly understood.

Язык: Английский

---

Attitudes toward deprescribing among older adults with dementia in the United States

Journal of the American Geriatrics Society, Год журнала: 2022, Номер 70(6), С. 1764 - 1773

Опубликована: Март 10, 2022

Abstract Background People with dementia (PWD) take medications that may be unnecessary or harmful. This problem can addressed through deprescribing, but it is unclear if PWD would willing to engage in deprescribing their providers. Our goal was investigate attitudes toward among PWD. Methods a cross‐sectional study of 422 aged ≥65 years who completed the module National Health and Aging Trends Study (NHATS) 2016. Proxies provided responses when participant unable respond due health cognitive problems. Attitudinal outcomes comprised two statements from patients' questionnaire its revised version (representing belief about necessity one's willingness deprescribe); another elicited maximum number pills respondent comfortable taking. Results The weighted sample represented over 1.8 million PWD; 39% were 75 84 old 38% 85 older, 60% female, 55% reported six more regular medications. for 26% Overall, 22% believed they taking one medicines no longer needed, 87% stop medications, 50% uncomfortable five similar across sociodemographic clinical factors. ≥6 likely endorse at least medication necessary compared those <6 (adjusted probability 29% [95% confidence interval (CI), 22%–38%] vs. 13% CI, 8%–20%]; p = 0.004); same applied deprescribe (92% 87%–95%] 83% 76%–89%]; 0.04). Conclusions A majority are deprescribe, representing an opportunity improve quality life this vulnerable population.

Язык: Английский

---

Implementation of pharmacist-led deprescribing in collaborative primary care settings

International Journal of Clinical Pharmacy, Год журнала: 2022, Номер 44(5), С. 1216 - 1221

Опубликована: Июль 6, 2022

Язык: Английский

---

Reducing inappropriate polypharmacy for older patients at specialist outpatient clinics: a systematic review

Current Medical Research and Opinion, Год журнала: 2023, Номер 39(4), С. 545 - 554

Опубликована: Фев. 27, 2023

Polypharmacy is associated with negative clinical consequences. The efficacy of deprescribing interventions within medical specialist outpatient clinics remains unclear. Here, we reviewed the research on effectiveness implemented for patients ≥ 60 years.Systematic searches key databases were undertaken studies published between January 1990 and October 2021. diverse nature study designs made it unsuitable pooling meta-analysis, thus, a narrative review was conducted presented in both text tabular formats. primary outcome that intervention resulted change medication load (either total number medications or appropriateness medication). Secondary outcomes maintenance deprescription benefits. Methodological quality publications assessed using revised Cochrane risk-of-bias tools.Nineteen 10,914 participants included review. These geriatric clinics, oncology/hematology hemodialysis designated polypharmacy/multimorbidity clinics. Four randomized controlled trials (RCTs) reported statistically significant reductions intervention; however, all had high risk bias. inclusion pharmacist aims to increase deprescribing, current evidence mainly restricted prospective pilot studies. data secondary very limited highly variable.Specialist may provide valuable settings implementing interventions. addition multidisciplinary team including use validated assessment tools appear be enablers. Further warranted.

Язык: Английский

---

Pharmacists’ contribution to benzodiazepine deprescribing in older outpatients: a systematic review and meta-analysis

International Journal of Clinical Pharmacy, Год журнала: 2023, Номер 45(5), С. 1037 - 1049

Опубликована: Сен. 15, 2023

Язык: Английский

---

Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting – a scoping review

BMC Geriatrics, Год журнала: 2020, Номер 20(1)

Опубликована: Ноя. 9, 2020

As the population ages, potentially inappropriate prescribing (PIP) in older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity mortality. Understanding factors that influence behaviour allow development interventions to reduce PIP. The aim this study is apply Theoretical Domains Framework (TDF) explore barriers effective for ambulatory setting.A scoping review was performed based on five-stage methodological framework developed by Arksey O'Malley. From 30 Aug 2018 5 Sep 2018, we conducted our search PubMed, CINAHL, EMBASE, Cochrane Database Systematic Reviews, Web Science. We also searched five electronic journals, Google Scholar identify additional sources grey literature. Two reviewers applied eligibility criteria title abstract screening, followed full text before systematically charting data.A total 5731 articles were screened. Twenty-nine studies met selection qualitative analysis. mapped results using 14-domain TDF, eventually identifying 10 domains interest prescribing. Of these, significant include physician-related such as "Knowledge", "Skills", "Social/Professional Role Identity"; issues with "Environmental Context Resources"; impact "Social Influences" "Emotion" behaviour.The TDF elicited multiple which both independently collectively lead setting. Changing climate will thus require targeting stakeholders, including physicians, patients hospital/clinic systems. Further work needed individual guide frameworks aid

Язык: Английский

---

Prevalence of Potentially Inappropriate Medications in Older Adults with Cognitive Impairment or Dementia Attending Memory Clinics: A Systematic Review and Meta-Analysis

Journal of Alzheimer s Disease, Год журнала: 2024, Номер 101(4), С. 1107 - 1120

Опубликована: Окт. 8, 2024

Background: Older adults with dementia who are on polypharmacy more vulnerable to the use of potentially inappropriate medications (PIM), which can significantly increase risk adverse events and drug-related problems (DRPs). Objective: This systematic review meta-analysis were conducted map prevalence PIM use, polypharmacy, hyper-polypharmacy among older cognitive impairment or attending memory clinics. Methods: Ovid MEDLINE, EMBASE, Scopus, Cochrane Library, EBSCOhost CINAHL, International Pharmaceutical Abstracts (IPA) systematically searched from inception April 22, 2024. Observational studies assessing PIMs CI screened. A random- effects was pool estimates. Results: Of 5,787 identified citations, 11 including 4,571 participants 8 countries included. Among all included pooled 38% (95% confidence interval (CIn): 27– 50%), highlighting a notable range 20% 78%. The analysis anticholinergics, benzodiazepines, non-benzodiazepine sedatives as most common PIMs. Subgroup revealed higher in USA (39%; 95% CIn: 10– 78, I2 (%) = 98, 3 studies) Australia (36%, 12– 70, 96, 2 Studies). Additionally, reported (60%; 46– 73, 95, studies), (The 17.6%; 1 study) respectively. Conclusions: definition impacts study results, often than geographical variations. variability criteria tools like Beers Screening Tool Persons’ Prescriptions (STOPP) across regions leads differing rates.

Язык: Английский

---

Feasibility of the Implementation of LESS-CHRON in Clinical Practice: A Pilot Intervention Study in Older Patients With Multimorbidity

Innovation in Aging, Год журнала: 2023, Номер 7(5)

Опубликована: Май 8, 2023

Abstract Background and Objectives Potentially inappropriate medication refers to the prescription of drugs whose risks outweigh benefits. There are different pharmacotherapeutic optimization strategies detect avoid potentially medications (PIMs), namely deprescription. The List Evidence-Based Deprescribing for Chronic Patients (LESS-CHRON) criteria were designed as a tool systematize deprescribing process. LESS-CHRON has established itself one most suitable be applied in older (≥65 years) multimorbid patients. However, it not been these patients, measure impact on their treatment. For this reason, pilot study was conducted analyze feasibility implementing care pathway. Research Design Methods A pre–post quasi-experimental conducted. Older outpatients with multimorbidity from Internal Medicine Unit benchmark Hospital included. main variable clinical practice, understood likelihood that intervention recommended by pharmacist would patient. Success rate, therapeutic, anticholinergic burden, other variables related health utilization analyzed. Results total 95 reports prepared. Forty-three evaluated physician who assessed recommendations made pharmacists. This translates into an implementation 45.3%. application identified 92 PIMs. acceptance rate 76.7% after 3 months 82.7% stopped remained deprescribed. reduction burden enhanced adherence achieved. no improvement found or variables. Discussion Implications pathway is feasible. achieved great successful insignificant percentage. Future studies larger sample size necessary obtain more robust results

Язык: Английский

---