Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action

European Journal of Internal Medicine, Год журнала: 2017, Номер 38, С. 3 - 11

Опубликована: Янв. 5, 2017

Язык: Английский

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Development and Validation of the Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire: Versions for Older Adults and Caregivers

Drugs & Aging, Год журнала: 2016, Номер 33(12), С. 913 - 928

Опубликована: Окт. 26, 2016

Язык: Английский

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Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

JAMA Internal Medicine, Год журнала: 2018, Номер 178(12), С. 1673 - 1673

Опубликована: Окт. 16, 2018

Use of harmful and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance discontinuing medication use a significant barrier deprescribing.To describe the attitudes toward deprescribing determine whether individual characteristics are associated with these attitudes.For this population-based survey study US Medicare beneficiaries 65 years older, data were obtained from Medication Attitudes module fielded through in-person interviews round 6 National Health Aging Trends Study (weighted response rate was 88.5%). The questions drawn Patients' Towards Deprescribing questionnaire its revised version. random one-third (n = 2124) participants 94.8%).Responses 2 statements ("If my doctor said it possible, I would be willing stop one or more regular medicines" "I like reduce number medicines am taking") main outcomes interest.Of 1981 included study, 1149 (55.2%, weighted) women, majority 715 [54.6%, weighted]) 74 old. A total 1752 (92.0%, reported being taking 1 their if physician 1241 (66.6%, wanted they taking. Older had greater odds than those fewer (adjusted ratio, 2.90; 95% CI, 1.74-4.82) wanting 2.31; 1.71-3.13).Physicians considering part comprehensive, patient-centered should reassured Americans open having deprescribed says two-thirds want

Язык: Английский

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Deprescribing Medications Among Older Adults From End of Hospitalization Through Postacute Care

JAMA Internal Medicine, Год журнала: 2023, Номер 183(3), С. 223 - 223

Опубликована: Фев. 6, 2023

Deprescribing is a promising approach to addressing the burden of polypharmacy. Few studies have initiated comprehensive deprescribing in hospital setting among older patients requiring ongoing care postacute (PAC) facility.

Язык: Английский

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Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines

The Journals of Gerontology Series B, Год журнала: 2017, Номер 73(7), С. e98 - e107

Опубликована: Окт. 16, 2017

Polypharmacy in the older population is increasing-and can be harmful. It safe to reduce or carefully cease medicines (deprescribing) but a collaborative approach between patient and doctor required. This study explores decision-making about polypharmacy with adults their companions. Semi-structured interviews were conducted 30 people (aged 75+ years, taking multiple medicines) 15 Framework analysis was used identify qualitative themes. Participants varied considerably attitudes towards medicines, preferences for involvement decision-making, openness deprescribing. Three types identified. Type 1 held positive preferred leave decisions doctor. 2 voiced ambivalent proactive role, open 3 frail, perceived they lacked knowledge deferred most companion. provides novel typology describe differences who are happy take those To enable shared prescribers need adapt communication based on patients' decisions.

Язык: Английский

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Attitudes of Older Adults and Caregivers in Australia toward Deprescribing

Journal of the American Geriatrics Society, Год журнала: 2019, Номер 67(6), С. 1204 - 1210

Опубликована: Фев. 13, 2019

BACKGROUND/OBJECTIVES Use of harmful and/or unnecessary medications in older adults is common. Understanding adult and caregiver attitudes toward deprescribing will contribute to medication optimization practice. The aims this study were capture the beliefs caregivers determine what participant characteristics (if any) predicted reported willingness have a deprescribed. DESIGN Self‐completed questionnaire. SETTING Australia. PARTICIPANTS Older (n = 386), 65 years or older, taking one more regular prescription 205) who could self‐complete written questionnaire English. MEASUREMENTS versions validated revised Patients’ Attitudes Towards Deprescribing (rPATD) completed. rPATD includes two global questions four factors: perceived burden medications, belief appropriateness concerns about stopping, involvement management. Participant characteristics, self‐rated health, trust physician, health autonomy also collected. RESULTS participants had median age 74 (interquartile range [IQR] 70‐81 y), aged 67 (IQR 59‐76) caring for person 81 75‐86.25 y). Most both (88%) (84%) agreed strongly that they would be willing stop their care recipient's if doctor said it was possible. In binary logistic regression model, low concern stopping factor score strongest predictor deprescribed (odds ratio [OR] 0.12; 95% confidence interval [CI] 0.04‐0.34). Excellent/good rating physical (OR 3.71; CI 1.13‐12.23). CONCLUSIONS are deprescribed, although different predictors (characteristics/attitudes) identified these groups.

Язык: Английский

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A systems approach to identifying the challenges of implementing deprescribing in older adults across different health-care settings and countries: a narrative review

Expert Review of Clinical Pharmacology, Год журнала: 2020, Номер 13(3), С. 233 - 245

Опубликована: Фев. 14, 2020

Introduction: There is increasing recognition of the need for deprescribing inappropriate medications in older adults. However, efforts to encourage implementation clinical practice have resulted mixed results across settings and countries.Area covered: Searches were conducted PubMed, Embase, Google Scholar June 2019. Reference lists, citation checking, personal reference libraries also utilized. Studies capturing main challenges of, opportunities for, implementing into selected health-care internationally, international deprescribing-orientated policies included summarized this narrative review.Expert opinion: Deprescribing intervention studies are inherently heterogeneous because complexity interventions employed often do not reflect real-world. Further research investigating enhanced required. Process evaluations needed determine contextual factors that important translation may be individually tailored target unique barriers different settings. Introduction national beneficial, but evaluated if there any unintended consequences.

Язык: Английский

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How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing?

Journal of Clinical Pharmacy and Therapeutics, Год журнала: 2018, Номер 43(4), С. 550 - 555

Опубликована: Апрель 22, 2018

What is known and objective Deprescribing the process of discontinuing or reducing dosage medications that are no longer appropriate aligned with goals care, which paramount in elderly patients multiple comorbidities polypharmacy. The this study was to assess perceptions primary care physicians on deprescribing for potential barriers experience Local Health Authority (LHA) Parma, Emilia-Romagna, Italy. Methods One hundred sixty (57% total number Parma) attended an educational session related were asked anonymously complete a paper survey. Participants their level agreement nine questions about perception factors affecting using seven-point Likert-type scale. A correlation coefficient calculated association between physicians' confidence attitudes associated deprescribing. Results discussion Many (72%) reported general ability deprescribe. Most respondents (78%) they comfortable preventive medications, yet only half (53%) guideline-recommended therapies. Lack evidence medicines concern withdrawal side effects impede by more than one-third physicians. When initially prescribed another physician, 40% hesitance them. About (45%) did not feel when patients/caregivers believed continuation medication needed. time difficulty engaging cited as one four There strong new conclusion results show believe generally deprescribing, although there still several hamper engage process. An improved understanding views may help guide further research, policies remain healthy while streamlining regimen.

Язык: Английский

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Poly-de-prescribing to treat polypharmacy: efficacy and safety

Therapeutic Advances in Drug Safety, Год журнала: 2017, Номер 9(1), С. 25 - 43

Опубликована: Окт. 27, 2017

Background: The aim of this study was to evaluate efficacy and safety poly-de-prescribing (PDP) based on the Garfinkel method in older people with polypharmacy. Methods: A longitudinal, prospective, nonrandomized Israel carried out between 2009 2016. Comprehensive geriatric assessments were performed at home age ⩾66 years consuming ⩾6 prescription drugs. Exclusion criteria life expectancy <6 months a seeming unwillingness cooperate (poor compliance). PDP ⩾3 drugs recommended. Follow up years. Between April 2015 2016 Likert scale questionnaires filled by all participants/families overall satisfaction clinical outcomes. outcome measures change functional, mental cognitive status, sleep quality, appetite, continence; major complication, hospitalizations, mortality, family doctor’s cooperation. Results: Poly-de-prescribing eventually achieved 122 participants (PDP group); ⩽2 stopped 55 ‘nonresponders’ (NR group). average 83.4 ± 5.3 group, 80.8 6.3 NR group ( p = 0.0045). 43.6 14 39.5 16.6 (NR) 0.09). prevalence most diseases/symptoms comparable except for higher dementia, incontinence functional decline group. main barrier de-prescribing adopt recommendations < 0.0001). baseline median number medications taken both groups 10 (IQR 8 12) 0.55). On last follow up, drug count 11 4 2 5) =0.0001). showed significantly less deterioration (sometimes improvement) general satisfaction, sphincter control, complications reduced 0.002 all). rate hospitalizations mortality comparable. Health improvement occurred within 3 after 83%, persisted ⩾2 68%. Conclusions: This self-selected sample longitudinal research strongly suggests that negative, usually invisible effects polypharmacy are reversible. is well tolerated associated improved outcomes, comparison outcomes who adhere guidelines take conventionally. Future double-blind studies will probably prove beneficial economic as well.

Язык: Английский

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Deprescribing medications for older adults in the primary care context: A mixed studies review

Health Science Reports, Год журнала: 2018, Номер 1(7)

Опубликована: Май 10, 2018

Abstract Aims This review investigates the factors that influence deprescribing of medications in primary care from perspective general practitioners (GPs) and community‐living older adults. Methods A mixed studies structure was adopted searching Scopus, CINAHL, PsychINFO, ProQuest, PubMed January 2000 to December 2017. manual search reference lists also conducted. Studies were included if they original research available English explored rather than a specific class medications. The Mixed Assessment Tool used assess quality studies, content analysis generated common categories across studies. Results Thirty‐eight articles included, 7 key identified. found are similar within health systems mostly act as barriers. These remained unchanged period. structural organisation remains poorly suited facilitate deprescribing. Individual knowledge gaps both GPs adults practices attitudes towards deprescribing, significant communication occur between specialists As result, decision making is characterised by uncertainty, often considered only when medication problems have already arisen. Trust plays complex role, acting barrier facilitator Conclusions Deprescribing influenced many factors. Despite recent interest, little change has occurred. Multilevel strategies aimed at reforming aspects system managing uncertainty practice individual level, notably reducing limitations closing communications gaps, may achieve change.

Язык: Английский

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