Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain
JAMA Network Open,
Год журнала:
2024,
Номер
7(3), С. e241342 - e241342
Опубликована: Март 6, 2024
Importance
Guidelines
recommend
deprescribing
opioids
in
older
adults
due
to
risk
of
adverse
effects,
yet
little
is
known
about
patient-clinician
opioid
conversations.
Objective
To
understand
the
experiences
and
primary
care
practitioners
(PCPs)
with
using
for
chronic
pain
discussing
deprescribing.
Design,
Setting,
Participants
This
qualitative
study
conducted
semistructured
individual
interviews
18
PCPs
29
65
years
or
prescribed
between
September
15,
2022,
April
26,
2023,
at
a
Boston-based
academic
medical
center.
The
were
asked
their
prescribing
adults.
Patients
medications
PCPs.
Main
Outcome
Measures
Shared
conflicting
themes
patients
regarding
perceptions
barriers
Results
In
total,
(12
[67%]
younger
that
50
years;
10
[56%]
female;
14
[78%]
based
an
practice)
(mean
[SD]
age,
72
[5]
19
[66%]
female)
participated.
conveyed
conversations
on
use
typically
challenging
risks
uncommon.
Three
common
related
emerged
both
patient
PCP
interviews:
used
as
last
resort,
improve
function
quality
life,
trust
was
vital
clinician-patient
relationship.
expressed
views
opioids,
focusing
addiction
drug
events.
Both
groups
felt
often
unsuccessful
but
had
successful
unnecessary
unless
event
occurred,
many
prior
negative
tapering.
described
gaps
knowledge
how
taper,
lack
clinical
access
monitor
during
tapering,
concerns
resistance.
Conclusions
Relevance
this
study,
receiving
long-term
therapy
viewed
beneficial
resort
treating
dissonant
associated
which
made
challenging.
Interventions,
such
conversation
aids,
are
needed
support
collaborative
discussion
opioids.
Язык: Английский
Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper
European Geriatric Medicine,
Год журнала:
2023,
Номер
14(6), С. 1195 - 1209
Опубликована: Окт. 9, 2023
Abstract
Inappropriate
polypharmacy
is
highly
prevalent
among
older
adults
and
presents
a
significant
healthcare
concern.
Conducting
medication
reviews
implementing
deprescribing
strategies
in
multimorbid
with
are
an
inherently
complex
challenging
task.
Recognizing
this,
the
Special
Interest
Group
on
Pharmacology
of
European
Geriatric
Medicine
Society
has
compiled
evidence
review
formulated
recommendations
to
enhance
appropriate
prescribing
practices.
The
current
supports
need
for
comprehensive
widespread
transformation
education,
guidelines,
research,
advocacy,
policy
improve
management
individuals.
Furthermore,
incorporating
as
routine
aspect
care
ageing
population
crucial.
We
emphasize
importance
involving
geriatricians
experts
geriatric
pharmacology
driving,
actively
participating
this
transformative
process.
By
doing
so,
we
can
work
towards
achieving
optimal
use
enhancing
well-being
generations
come.
Язык: Английский
Low back pain-related healthcare utilization following intraosseous basivertebral nerve radiofrequency ablation: a pooled analysis from three prospective clinical trials
Pain Medicine,
Год журнала:
2023,
Номер
25(1), С. 20 - 32
Опубликована: Авг. 29, 2023
Abstract
Background
The
effectiveness
and
safety
of
intraosseous
basivertebral
nerve
ablation
(BVNA)
for
treating
vertebrogenic
pain
is
established,
but
low
back
pain-related
healthcare
utilization
(LBPr-HU)
following
BVNA
continues
to
be
defined.
Methods
LBPr-HU
data
were
pooled
from
3
prospective
studies.
categories
interest
included
non-invasive
conservative
care,
opioid
utilization,
lumbosacral
spinal
injection
(LSI),
radiofrequency
(LRFA),
surgery.
Pre-
post-BVNA
compared
at
both
1-
5-years
using
McNemar’s
test
proportions
paired
t-tests
means.
Results
Two
hundred
forty-seven
patients
received
had
1-year
follow-up;
205
long-term
follow-up
(mean
5.3
±
1.33
years).
Twenty-seven
percent
fewer
participants
initiated
care
in
the
year
preceding
(P
<
.001;
95%
CI
19.8–34.5).
Of
77/247
taking
opioids
baseline,
40.3%
61.7%
them
one-year
years
post-BVNA,
respectively
.001).
receiving
LSIs
BVNA,
81.2%
LSI(s)
70.7–90.7);
a
76.4%
reduction
was
maintained
through
mean
post-BVNA.
LRFA
rates
1.6%
8.3%
Lumbar
fusion
surgery
0.8%
6.5%
Conclusions
In
this
aggregate
analysis
with
pain,
opioids,
LSIs,
substantially
reduced
5
baseline.
less
than
half
published
value
similar
populations.
Язык: Английский
Minimising Harm and Managing Pain: Deprescribing Opioids in Older Adults
Drugs & Aging,
Год журнала:
2024,
Номер
unknown
Опубликована: Окт. 29, 2024
Язык: Английский
Medication use quality and safety in older adults: 2022 update
Journal of the American Geriatrics Society,
Год журнала:
2023,
Номер
72(5), С. 1329 - 1337
Опубликована: Дек. 1, 2023
Abstract
Improving
the
quality
of
medication
use
and
safety
are
important
priorities
for
healthcare
providers
who
care
older
adults.
The
objective
this
article
was
to
identify
four
exemplary
articles
with
focus
in
2022.
We
selected
high‐quality
studies
from
an
OVID
search
hand
searching
major
high
impact
journals
that
advanced
field
research
forward.
chosen
cover
domains
related
deprescribing,
safety,
optimizing
use.
MedSafer
Study,
a
cluster
randomized
clinical
trial
Canada,
evaluated
whether
patient
specific
deprescribing
reports
generated
by
electronic
decision
support
software
resulted
reduced
adverse
drug
events
30
days
post
hospital
discharge
adults
(domain:
deprescribing).
second
study,
retrospective
cohort
study
using
data
Premier
Healthcare
Database,
examined
in‐hospital
associated
perioperative
gabapentin
among
undergoing
surgery
safety).
third
used
open‐label
parallel
controlled
39
Australian
aged‐care
facilities
examine
effectiveness
pharmacist‐led
intervention
reduce
medication‐induced
deterioration
reactions
use).
Lastly,
fourth
engaged
experts
Delphi
method
process
develop
consensus
list
clinically
prescribing
cascades
adversely
affect
persons'
health
aid
clinicians
identify,
prevent,
manage
Collectively,
review
succinctly
highlights
pertinent
topics
promoting
safe
medications
promotes
awareness
adults'
regimens.
Язык: Английский
Issue Information
Journal of the American Geriatrics Society,
Год журнала:
2023,
Номер
71(5), С. 1351 - 1357
Опубликована: Май 1, 2023
WHO
WE
AREFounded
in
1942,
the
American
Geriatrics
Society
(AGS)
is
a
nationwide,
not-for-profit
society
of
geriatrics
healthcare
professionals
dedicated
to
improving
health,
independence,
and
quality
life
older
people.Our
members
include
thousands
geriatricians,
advanced
practice
nurses,
social
workers,
family
practitioners,
physician
assistants,
pharmacists,
internists
who
are
pioneers
advanced-illness
care
for
individuals,
with
focus
on
championing
interprofessional
teams,
eliciting
personal
goals,
treating
people
as
whole
persons.The
provides
leadership
professionals,
policymakers,
public
by
implementing
advocating
programs
clinical
care,
research,
professional
education,
policy
that
can
support
us
all
we
age.
OUR
MISSIONTo
improve
people.
VISION
FOR
THE
FUTUREWe
able
contribute
our
communities
maintain
safety,
independence
age.We
have
access
high-quality,
person-centered
informed
principles
free
ageism.We
supported
where
ageism,
ableism,
classism,
homophobia,
racism,
sexism,
xenophobia,
other
forms
bias
discrimination
no
longer
impact
access,
quality,
outcomes
adults
their
caregivers.
STRATEGIES
ACHIEVING
VISION1.
Expanding
knowledge
base
disseminating
basic,
clinical,
health
services
research
focused
people.2.
Increasing
number
employing
when
caring
diverse
persons
supporting
integration
concepts
into
education.3.
Recruiting
trainees
focusing
rewards
potential
career
people.4.
Advocating
promotes
Americans,
goal
life,
systems
serving
5.
Creating
awareness
about
ways
remaining
active,
independent,
engaged
communities.6.
Working
across
strategic
priorities
identify
eliminate
structural
bias/discrimination
given
LEARN
MOREVisit
www.americangeriatrics.org
learn
more
its
programs.
Язык: Английский