Barriers and facilitators to deprescribing in primary care: a systematic review

BJGP Open, Год журнала: 2020, Номер 4(3), С. bjgpopen20X101096 - bjgpopen20X101096

Опубликована: Июль 28, 2020

Background Managing polypharmacy is a challenge for healthcare systems globally. It also health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care patients with multimorbidity occurs primary care. Safe deprescribing interventions reduce exposure inappropriate polypharmacy. However, these are not fully accepted or routinely implemented. Aim To identify barriers facilitators safe adults Design & setting A systematic review studies published from 2000, examining Method search electronic databases: MEDLINE, Embase, Cumulative Index Nursing Allied Health Literature (CINHAL), Cochrane, Management Information Consortium (HMIC) inception 26 Feb 2019, using an agreed strategy. This was supplemented by handsearching relevant journals, screening reference lists citations included studies. Results In total, 40 14 countries were identified. Cultural organisational included: culture diagnosing prescribing; evidence-based guidance focused on single diseases; lack care older people multimorbidities; shared communication, decision-making systems, tools, resources. Interpersonal individual-level professional etiquette; fragmented care; prescribers’ patients’ uncertainties; gaps tailored support. Facilitators prudent greater availability acceptability non-pharmacological alternatives; resources; improved collaboration, knowledge, understanding; patient-centred decision-making. Conclusion whole approach required, involving key decision-makers, professionals, patients, carers.

Язык: Английский

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Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review

npj Aging, Год журнала: 2024, Номер 10(1)

Опубликована: Янв. 23, 2024

Abstract Polypharmacy, commonly defined as ≥5 medications, is a rising public health concern due to its many risks of harm. One recommended strategy address polypharmacy medication reviews, with subsequent deprescription inappropriate medications. In this review, we explore the intersection older age, polypharmacy, and deprescribing in contemporary context by appraising published literature (2012–2022) identify articles that included new primary data on medications patients aged ≥65 years currently taking We found 31 were which describe current perceptions clinicians towards deprescribing, identified barriers, key enabling factors, future directions approaching deprescribing. Currently, believe complex process, despite majority reporting feeling comfortable fewer engage process regularly. Common barriers cited include lack knowledge training around time, breakdown communication, perceived ‘abandonment care’, fear adverse consequences, resistance from and/or their carers. factors recognition opportunities instigate regular improving lines education both multidisciplinary approach patient care. Addressing requires nuanced generally group patients. Key strategies reducing clinicians, addition communication between healthcare providers approach.

Язык: Английский

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Barriers and facilitators of implementing proactive deprescribing within primary care: a systematic review

International Journal of Pharmacy Practice, Год журнала: 2023, Номер 31(2), С. 126 - 152

Опубликована: Март 1, 2023

Abstract Objective Proactive deprescribing – identifying and discontinuing medicines where harms outweigh benefits can minimise problematic polypharmacy, but has yet to be implemented into routine practice. Normalisation process theory (NPT) provide a theory-informed understanding of the evidence base on what impedes or facilitates normalisation safe in primary care. This study systematically reviews literature identify barriers facilitators implementing care their effect potential using NPT. PubMed, MEDLINE, Embase, Web Science, International Pharmaceutical Abstracts, CINAHL, PsycINFO The Cochrane Library were searched (1996–2022). Studies any design investigating implementation included. Mixed Methods Appraisal Tool Quality Improvement Minimum Criteria Set used appraise quality. Barriers from included studies extracted mapped constructs Key findings A total 12,027 articles identified, 56 In total, 178 condensed 14 16 facilitators. Common negative perceptions suboptimal environments, while common structured education training proactive utilising patient-centred approaches. Very few associated with reflexive monitoring, highlighting paucity how interventions are appraised. Summary Through NPT, multiple identified that impede facilitate However, more research is needed appraisal post-implementation.

Язык: Английский

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Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis

Health Technology Assessment, Год журнала: 2022, Номер 26(32), С. 1 - 148

Опубликована: Июль 1, 2022

Tackling problematic polypharmacy requires tailoring the use of medicines to individual needs and circumstances. This may involve stopping (deprescribing) but patients clinicians report uncertainty on how best do this. The TAILOR medication synthesis sought help understand support deprescribing in older people living with multimorbidity polypharmacy.

Язык: Английский

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Polypharmacy and Drug–drug Interactions in Older and Younger People Living with HIV: The POPPY Study

Antiviral Therapy, Год журнала: 2018, Номер 24(3), С. 193 - 201

Опубликована: Апрель 1, 2018

Background Polypharmacy (use of ≥ five medications) increases the risk drug-drug interactions and can lead to negative health outcomes. This study aimed review medications people living with HIV (PLWH) HIV-negative controls in POPPY evaluate frequency polypharmacy potential (PDDIs). Methods PDDIs between non-antiretroviral (ARV) drugs were analysed using Lexicomp® database, non-ARV ARV Liverpool drug interaction database. Between-group differences assessed χ 2 , Mann-Whitney U Kruskal-Wallis tests. Results analysis included 698 PLWH ≥50 years, 374 <50 years 304 years. The prevalence was 65.8% older PLWH, 48.1% younger 13.2% group. When ARVs excluded, 29.8% 14.2% had polypharmacy. ≥1 PDDI involving 36.1%, 20.3% 16.4%, respectively, controls. In 57.3% 32.4% PLWH. Conclusions non-ARV/ARV non-ARV/non-ARV common among highlighting need for increased awareness additional research on all types PDDI.

Язык: Английский

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Health care professionals' attitudes towards deprescribing in older patients with limited life expectancy: A systematic review

British Journal of Clinical Pharmacology, Год журнала: 2019, Номер 85(5), С. 868 - 892

Опубликована: Янв. 10, 2019

Aims The aim of this systematic review was to explore health care professionals' attitudes towards deprescribing in older people with limited life expectancy. Methods A literature search conducted from inception December 2017 using MEDLINE, EMBASE and CINAHL. Studies were included if they specifically concerned (≥65 years) expectancy, including those residing any type aged facility, or based on representative patient profiles. Results analyzed inspired by the Joanna Briggs Institute's method for synthesis qualitative data. characterized a checklist reporting research. Eight studies included. Six explored views general, two focused psychotropic agents. All eight physicians, mostly general practitioners, while three also considered other professionals. Four themes related identified: (i) relative involvement; (ii) importance teamwork; (iii) self‐assurance skills; (iv) impact organizational factors. Within each these themes, 3–4 subthemes identified analysed. Conclusions Our results suggest that decisions engage activities expectancy depend multiple factors which are highly interdependent. Consequently, there is an urgent need more research how approach clinical practice within population.

Язык: Английский

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Going Beyond the Guidelines in Individualising the Use of Antihypertensive Drugs in Older Patients

Drugs & Aging, Год журнала: 2019, Номер 36(8), С. 675 - 685

Опубликована: Июнь 7, 2019

Язык: Английский

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Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study

Journal of the American Geriatrics Society, Год журнала: 2020, Номер 68(4), С. 746 - 753

Опубликована: Фев. 17, 2020

OBJECTIVES Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults, yet patients' and caregivers' perspectives on medication value how this affects their willingness discontinue a are poorly understood. We sought identify the most significant factors that impact perceived of from perspective patients caregivers. DESIGN Qualitative study using focus groups conducted September October 2018. SETTING Participants Pepper Geriatric Research Registry (patients) Pitt+Me (caregivers) maintained by University Pittsburgh. PARTICIPANTS Six community‐dwelling adults aged 65 years older, caregivers, prescribed five more preceding 12 months. MEASUREMENTS (1) general views what makes worth taking; (2) specific features such as cost side effects value; (3) reactions clinical scenarios related deprescribing. RESULTS identified four themes. Perceived effectiveness was primary factor caused participants consider be high value. considered low if it adversely affected quality life. also cited when determining value, especially resulted material sacrifices. valued providers with whom they had good relationships rather than valuing level training. When presented scenarios, ably weighed these indicated whether would adhere recommendation. CONCLUSION effectiveness, adverse life, cost, strong relationship prescriber influenced These findings will enable prescribers engage shared allow health systems incorporate patient‐centered assessment into systems‐based interventions. J Am Geriatr Soc 68:746–753, 2020

Язык: Английский

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Interventions for reducing anticholinergic medication burden in older adults—a systematic review and meta-analysis

Age and Ageing, Год журнала: 2023, Номер 52(9)

Опубликована: Сен. 1, 2023

Abstract Introduction Anticholinergic medications block the neurotransmitter acetylcholine in brain and peripheral nervous system. Many have anticholinergic properties, cumulative effect of these is termed burden. Increased burden can short-term side effects such as dry mouth, blurred vision urinary retention well long-term including dementia, worsening physical function falls. Methods We carried out a systematic review (SR) with meta-analysis (MA) looking at randomised controlled trials addressing interventions to reduce older adults. Results identified seven papers suitable for inclusion our SR MA. Interventions included multi-disciplinary involvement medication reviews deprescribing AC medications. Pooled data revealed no significant difference outcomes between control intervention group falls (OR = 0.76, 95% CI: 0.52–1.11, n 647), cognition (mean 1.54, −0.04 3.13, 405), 0.04, −0.11 0.18, 710) or quality life 0.12, 461). Discussion Overall, there was As we did not see change scores following interventions, it likely other would change. Short follow-up time lack training support surrounding successful may contributed.

Язык: Английский

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Barriers to conducting deprescribing in the elderly population amid the COVID-19 pandemic

Research in Social and Administrative Pharmacy, Год журнала: 2020, Номер 17(1), С. 1942 - 1945

Опубликована: Май 29, 2020

Язык: Английский

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