Reducing Polypharmacy from the Perspectives of General Practitioners and Older Patients: A Synthesis of Qualitative Studies

Drugs & Aging, Год журнала: 2016, Номер 33(4), С. 249 - 266

Опубликована: Фев. 25, 2016

Язык: Английский

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Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

International Journal of Clinical Pharmacy, Год журнала: 2015, Номер 37(5), С. 949 - 957

Опубликована: Июнь 5, 2015

Язык: Английский

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Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review

BMC Pharmacology and Toxicology, Год журнала: 2015, Номер 16(1)

Опубликована: Июль 3, 2015

Long-term sedative use is prevalent and associated with significant morbidity, including adverse events such as falls, cognitive impairment, sedation. The development of dependence can pose challenges when discontinuation attempted withdrawal symptoms often develop. We conducted a scoping review to map characterize the literature determine opportunities for future research regarding deprescribing strategies long-term benzodiazepine Z-drug (zopiclone, zolpidem, zaleplon) in community-dwelling adults.We searched PubMed, Cochrane Central Register Controlled Trials, EMBASE, PsycINFO, CINAHL, TRIP, JBI Ovid databases grey search. Articles discussing methods benzodiazepines or Z-drugs adults were selected.Following removal duplicates, 2797 articles reviewed eligibility. Of these, 367 retrieved full-text assessment 139 subsequently included review. Seventy-four (53%) original research, predominantly randomized controlled trials (n = 52 [37%]), whereas 58 (42%) narrative reviews seven (5%) guidelines. Amongst studies, pharmacologic most commonly studied intervention 42 [57%]). Additional psychological therapies 10 [14%]), mixed interventions 12 [16%]), others [14%]). Behaviour change combined enablement 56 [76%]), education 36 [47%]), training 29 [39%]). Gradual dose reduction was frequently component reviews, guidelines, but varied widely.Approaches proposed are numerous heterogeneous. Current this area using meta-analyses may too narrowly encompass potential available target phenomenon. Realist synthesis would be well suited understand mechanisms by which work why they fail.

Язык: Английский

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Withdrawal of antihypertensive drugs in older people

Cochrane library, Год журнала: 2020, Номер 2020(6)

Опубликована: Июнь 10, 2020

Язык: Английский

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Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review

Therapeutic Advances in Drug Safety, Год журнала: 2018, Номер 9(9), С. 559 - 573

Опубликована: Июль 12, 2018

Prescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment formulary restrictions. With the increasing uptake electronic medical records (EMRs) hospitals, clinics residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at point care. This narrative review assessed process outcomes using EMR-enabled CDSS to reduce PIMs. We searched PubMed relevant articles published up January 2018 focused on those described assisted prescribers make changes time ordering PIMs adults. Computerized offering only medication reconciliation, dose checks, monitoring errors, or basic information were not included. In addition outcome measures medication-related processes adverse drug events, qualitative data relating factors influence effectiveness also gathered from selected studies. analysed 20 studies comprising 10 randomized trials observational performed hospitals (

Язык: Английский

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Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Journal of Pharmacy Practice and Research, Год журнала: 2020, Номер 50(1), С. 98 - 107

Опубликована: Фев. 1, 2020

Abstract The importance of deprescribing, which is the process withdrawing an inappropriate medication, supervised by a healthcare professional with goal managing polypharmacy and improving outcomes, increasingly recognised as part good clinical care. With this, number tools have been developed purpose aiding health professionals to deprescribe in regular practice. types vary significantly their form include aid overall deprescribing (such generic frameworks drug‐specific guidelines) well that may assist specific identifying medications or engaging patient). While many are available, most provide little (if any) information on how they were developed, limited implementation research has conducted. This paper provides overview available might be used

Язык: Английский

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Advancing the Science of Deprescribing: A Novel Comprehensive Conceptual Framework

Journal of the American Geriatrics Society, Год журнала: 2019, Номер 67(10), С. 2018 - 2022

Опубликована: Авг. 20, 2019

Polypharmacy is common in older adults and associated with inappropriate medication use, adverse drug events, nonadherence, higher costs, increased mortality compared those without polypharmacy. Deprescribing, the clinically supervised process of stopping or reducing dose medications when they cause harm no longer provide benefit, may improve outcomes. Although potentially beneficial, clinicians struggle to overcome structural, organizational, technological, cognitive barriers deprescribing, limiting its use clinical practice. Deprescribing science would benefit from a unifying conceptual framework prioritize research. Current deprescribing frameworks have made important contributions field but often focus on specific classes aspects deprescribing. To further this relatively nascent field, we developed broader that builds prior includes patient, prescriber, system influences; deprescribing; outcomes; dissemination. Patient factors include patients' biology, experience, values, preferences. Prescriber rational (eg, based explicit knowledge) nonrational behavioral tendencies, biases, heuristics) decision making. System resources, incentives, goals, culture contribute The separates . captures results by examining changes structures, performance processes, patient health outcomes, cost. Through testing refinement, novel, more comprehensive has potential advance research organizing existing evidence, identifying evidence gaps, categorizing interventions settings which are applied. J Am Geriatr Soc 67:2018–2022, 2019

Язык: Английский

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What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis

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

Опубликована: Сен. 25, 2023

A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate (deprescribing). Recent recommendations for effective deprescribing include shared-decision making a multidisciplinary approach. Our aim was understand when, why, how interventions review involving teams (MDTs) work (or do not work) people.

Язык: Английский

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A Proposed Curricular Framework for an Interprofessional Approach to Deprescribing

Medical Science Educator, Год журнала: 2023, Номер 33(2), С. 551 - 567

Опубликована: Фев. 23, 2023

Deprescribing involves reducing or stopping medications that are causing more harm than good no longer needed. It is an important approach to managing polypharmacy, yet healthcare professionals identify many barriers. We present a proposed pre-licensure competency framework describes essential knowledge, teaching strategies, and assessment protocols promote interprofessional deprescribing skills. The considers how involve patients care partners in decisions. An action plan example curriculum mapping exercise included help educators assess their curricula, select implement these concepts strategies within programs ensure learners graduate with competencies manage increasingly complex medication regimens as people age.The online version contains supplementary material available at 10.1007/s40670-022-01704-9.

Язык: Английский

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Adverse drug reactions in an ageing PopulaTion (ADAPT) study: Prevalence and risk factors associated with adverse drug reaction-related hospital admissions in older patients

Frontiers in Pharmacology, Год журнала: 2023, Номер 13

Опубликована: Янв. 13, 2023

Background: Older people experience greater morbidity with a corresponding increase in medication use resulting potentially higher risk of adverse drug reactions (ADRs). Objectives: The aim this study was to; 1) determine the prevalence and characteristics ADR-related hospital admissions among older patients (≥65 years) Ireland; 2) identify factors associated admissions. Methods: A cross-sectional ADR aged ≥65 years admitted acutely to Ireland over 8 month period (November 2016- June 2017). multifaceted review each admission undertaken assess likelihood an being reason for (cause or contributing admission) context patient's medication, clinical conditions, comorbidities investigations. number decision aids were applied by two independent reviewers causality, avoidability severity. random sample patients, determined not have suspected on screening, assigned non-ADR control group. Multivariable logistic regression used association between potential compared non-ADR-related Results: In total, 3,760 episodes (in 3,091 patients) screened 377 considered (10.0%, 95% CI 9.1%, 11.0%). 219 (58.1%) caused ADR, while ADRs contributed 158 (41.9%) 268 (71.1%) all deemed definitely possibly preventable/avoidable. 350 (92.8%) classified as moderate severity, 27 (7.2%) severe. Antithrombotic agents, mainly aspirin warfarin, drugs most frequently (gastrointestinal vascular haemorrhagic disorders). multivariable analysis, immobility, frailty, having delirium ulcer disease taking anticoagulant antiplatelet significantly admission. Conclusion: One ten admissions, those 65 + years, ADR-related, approximately 70% avoidable. Reliable validated detection prediction tools are needed develop prevention strategies.

Язык: Английский

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