Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

British Journal of General Practice, Год журнала: 2016, Номер 66(649), С. e552 - e560

Опубликована: Июнь 6, 2016

Background

Deprescribing describes the complex process that is required for safe and effective cessation of medications are likely to cause more harm than benefit. Knowledgeof older adults' carers' attitudes towards deprescribing will enhance shared decision making in medication optimisation.

Aim

To explore views, beliefs, adults carers on deprescribing.

Design setting

Qualitative focus group study New South Wales, Australia.

Method

Four groups with 14 were conducted. Results analysed using a previously developed framework (directed content analysis) additional conventional analysis.

Results

The willingness both have one or deprescribed was influenced by following main themes: their perception appropriateness medication; fear outcomes withdrawal; dislike taking medications; availability withdrawal (including discussion healthcare professional knowing could be restarted if necessary). A patient's regular GP identified as strong influence against withdrawal. themes supported framework. An theme unique complexity involved decisions about care recipients.

Conclusion

This highlights discussions between olderadult carer withdrawing should address reasons GPs aware major patients regularly discuss current use carers.

Язык: Английский

---

Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review

Implementation Science, Год журнала: 2016, Номер 11(1)

Опубликована: Дек. 1, 2016

Collaborative care is an increasingly popular approach for improving quality of people with mental health problems through intensified and structured collaboration between primary providers professionals specialized psychiatric expertise. Trials have shown significant positive effects patients suffering from depression, but since collaborative a complex intervention, it important to understand the factors which affect its implementation. We present qualitative systematic review enablers barriers implementing anxiety depression. developed comprehensive search strategy in cooperation research librarian performed five databases (EMBASE, PubMed, PsycINFO, ProQuest, CINAHL). All authors independently screened titles abstracts reviewed full-text articles. Studies were included if they published English based on original data implementation intervention targeted at depression or adult patient population high-income country. Our subsequent analysis employed normalization process theory (NPT). 17 studies our 11 conducted USA, UK, one Canada. identified several within four major analytical dimensions NPT. Securing buy-in among was found be critical sometimes difficult. Enablers physician champions, reimbursement extra work, feedback effectiveness care. The social professional skills managers seemed integrating clinic. Day-to-day also facilitated by being located clinic this supports regular face-to-face interactions physicians managers. following areas require special attention when planning interventions: effective educational programs, especially managers; issues relation providers; good systems communication monitoring; promoting interaction physicians, preferably co-location. There need well-sampled, in-depth settings outside USA UK.

Язык: Английский

---

Methodology for Developing Deprescribing Guidelines: Using Evidence and GRADE to Guide Recommendations for Deprescribing

PLoS ONE, Год журнала: 2016, Номер 11(8), С. e0161248 - e0161248

Опубликована: Авг. 12, 2016

Class specific deprescribing guidelines could help clinicians taper and stop medications no longer needed or which may be causing more harm than benefit. We set out to develop methodology create such using evidence-based methods for guideline development, evidence synthesis recommendation rating.Using a comprehensive checklist successful enterprise, we conducted national modified Delphi consensus process identify priorities guidelines, then scoping exercises feasible topics, sequentially developed three guidelines. selected development team members clinical expertise; GRADE member worked with staff ensure processes were followed. used systematic searches reviews of trials drug classes, class effectiveness, narrative syntheses contextual questions inform recommendations development. Our 8 step included defining scope purpose, developing logic model guide the generate key questions, setting criteria admissible conducting reviews, synthesizing considering additional information performing quality estimates, formulating providing strength estimations, adding considerations, stakeholder review finally updating content pre-publication. Innovative aspects outcomes tapering stopping medication, incorporating medication into rating. Through (for proton pump inhibitors, benzodiazepine receptor agonists antipsychotics) associated decision-support algorithms, able gradually hone methodology; each will published separately.Our demonstrates importance searching short long-term outcomes, showing benefits studying patient preferences. This publication support future

Язык: Английский

---

Routine deprescribing of chronic medications to combat polypharmacy

Therapeutic Advances in Drug Safety, Год журнала: 2015, Номер 6(6), С. 212 - 233

Опубликована: Ноя. 3, 2015

The positive benefit–risk ratio of most drugs is decreasing in correlation to very old age, the extent comorbidity, dementia, frailty and limited life expectancy (VOCODFLEX). First, we review inappropriate medication use polypharmacy (IMUP) globally highlight its negative medical, nursing, social economic consequences. Second, expose main clinical/practical perceptual obstacles that combine create vicious circle eventually makes us feel frustrated hopeless treating VOCODFLEX general, our ‘war against IMUP’ particular. Third, summarize international approaches/methods suggested tried different countries an attempt improve ominous clinical outcomes IMUP; these include a variety clinical, pharmacological, computer-assisted educational programs. Lastly, suggest new comprehensive perception for providing good medical practice 21st century. This includes principles research, education guidelines completely from ‘single disease model’ research rules were raised upon somehow ‘fanatically’ adopted 20th perception, based on palliative, geriatric ethical principle, may provide fresh tools general reducing IMUP

Язык: Английский

---

What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals

BMJ Open, Год журнала: 2016, Номер 6(3), С. e009781 - e009781

Опубликована: Март 1, 2016

Polypharmacy and multimorbidity are common in long-term care facilities (LTCFs). Reducing polypharmacy may reduce adverse events maintain quality of life. Deprescribing refers to reducing medications after consideration therapeutic goals, benefits risks, medical ethics. The objective was use nominal group technique (NGT) generate then rank factors that general practitioners (GPs), nurses, pharmacists residents or their representatives perceive most important when deciding whether not deprescribe medications.Qualitative research using NGT.Participants were invited if they worked with, resided LTCFs across metropolitan regional South Australia.11 residents/representatives, 19 GPs, 12 nurses 14 participated six separate groups.Individual groups residents/representatives convened. Using NGT each ranked perceived be deprescribe. Then, NGT, the prioritised from individual discussed by a multidisciplinary comprised resident representatives, pharmacists.No two had same priorities. GPs 'evidence for deprescribing' 'communication with family/resident' as factors. Nurses 'GP receptivity 'nurses ability advocate residents' important. Pharmacists 'clinical appropriateness therapy' 'identifying goals care' Residents 'wellbeing resident' 'continuity nursing staff' 'adequacy medication history' important.While different factors, contrasting emerged. Future deprescribing interventions need consider similarities differences within range health professionals.

Язык: Английский

---