Research in Social and Administrative Pharmacy, Год журнала: 2021, Номер 18(3), С. 2550 - 2555
Опубликована: Июнь 6, 2021
Язык: Английский
Nature Reviews Disease Primers, Год журнала: 2022, Номер 8(1)
Опубликована: Июль 14, 2022
Язык: Английский
Процитировано
576
BMJ, Год журнала: 2024, Номер unknown, С. e074892 - e074892
Опубликована: Май 7, 2024
Abstract Polypharmacy is common in older adults and associated with adverse drug events, cognitive functional impairment, increased healthcare costs, risk of frailty, falls, hospitalizations, mortality. Many barriers exist to deprescribing, but efforts have been made develop implement deprescribing interventions that overcome them. This narrative review describes intervention components summarizes findings from published randomized controlled trials tested polypharmacy, as well reports on ongoing trials, guidelines, resources can be used facilitate deprescribing. Most were medication reviews primary care settings, many contained such shared decision making and/or a focus patient priorities, training for professionals, facing education materials, involvement family members, representing great heterogeneity addressing polypharmacy adults. Just over half study found perform better than usual at least one their outcomes, most assessed 12 months or less.
Язык: Английский
Процитировано
20
Frontiers in Medicine, Год журнала: 2023, Номер 10
Опубликована: Март 8, 2023
The main complications of polypharmacy, which is known as the simultaneous use more than five drugs, are potentially inappropriate medicines(PIMs), drug-drug, and drug-disease interaction. It aimed to prepare an auxiliary tool reduce polypharmacy support rational drug use(RDU), by evaluating patient with age, chronic diseases in this study.In first phase study, methodological research, up-to-date comprehensive a reference method was generated database containing interaction information 430 most commonly used agents geriatrics light current valid 6 PIM criteria for geriatric patients, medication prospectuses, relevant articles, guidelines. Then, artificial intelligence(AI) supported web application designed developed facilitate practical tool. Afterward, data cross-sectional observational single-center study were rate time detection application. proposed publicly available at https://fastrational.com/.While coverage 75.3%, EU(7)-PIM, US-FORTA, TIME-to-STOPP, Beers 2019, STOPP, Priscus respectively(63.5%-19.5%) from highest lowest. includes all PIMs, detected other criteria. A general practitioner detects interactions without 2278 s on average, while decreased 33.8 situation statistically significant.In literature alone insufficient include actively medicines it shows heterogeneity. In addition, many studies showed that biggest obstacle regulation practice "time constraints." analyzes specifically 60 times faster manual method, provides quick access references, ultimately supports RDU clinician, only AI-supported
Язык: Английский
Процитировано
29
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
Процитировано
25
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
Процитировано
25
BMJ, Год журнала: 2023, Номер unknown, С. e074054 - e074054
Опубликована: Май 24, 2023
To study the effects of a primary care medication review intervention centred around an electronic clinical decision support system (eCDSS) on appropriateness and number prescribing omissions in older adults with multimorbidity polypharmacy compared discussion about line usual care.Cluster randomised trial.Swiss care, between December 2018 February 2021.Eligible patients were ≥65 years age three or more chronic conditions five long term medications.The to optimise pharmacotherapy eCDSS was conducted by general practitioners, followed shared making practitioners patients, practitioners.Primary outcomes improvement Medication Appropriateness Index (MAI) Assessment Underutilisation (AOU) at 12 months. Secondary included medications, falls, fractures, quality life.In 43 practitioner clusters, 323 recruited (median 77 (interquartile range 73-83) years; 45% (n=146) women). Twenty one 160 assigned group 22 163 control group. On average, recommendation stop start reported be implemented per patient. At months, results intention-to-treat analysis (odds ratio 1.05, 95% confidence interval 0.59 1.87) (0.90, 0.41 1.96) inconclusive. The same case for protocol analysis. No clear evidence found difference safety month follow-up, but fewer events than six months.In this trial adults, inconclusive as whether use led reduction months care. Nevertheless, could safely delivered without causing any harm patients.NCT03724539Clinicaltrials.gov NCT03724539.
Язык: Английский
Процитировано
22
BMJ Quality & Safety, Год журнала: 2024, Номер unknown, С. bmjqs - 017101
Опубликована: Май 24, 2024
Introduction Deprescribing ( medication dose reduction or cessation ) is an integral component of appropriate prescribing. The extent to which deprescribing recommendations are included in clinical practice guidelines unclear. This scoping review aimed identify that contain recommendations, qualitatively explore the content and format estimate proportion recommendations. Methods Bibliographic databases Google were searched for published English from January 2012 November 2022. Guideline registries 2017 February 2023. Two reviewers independently screened records containing one more A 10% sample guideline was eligible a recommendation. recommendation characteristics extracted language features including content, form, complexity readability examined using conventional analysis SHeLL Health Literacy Editor tool. Results 80 316 included. had substantial variability their terminology. Most contained regarding who (75%, n=60) , what (99%, n=89) when why (91%, n=73) deprescribe, however, fewer (58%, n=46) detailed guidance on how deprescribe. Approximately 29% identified (n=14/49) Conclusions increasingly being incorporated into guidelines, many do not clear actionable deprescribe may limit effective implementation practice. co-designed template best guide, information aspects essential preferred by end-users should be developed employed. Trial registration number osf.io/fbex4.
Язык: Английский
Процитировано
9
Geriatric Nursing, Год журнала: 2025, Номер 62, С. 1 - 11
Опубликована: Фев. 4, 2025
Язык: Английский
Процитировано
1
Systems Research and Behavioral Science, Год журнала: 2025, Номер unknown
Опубликована: Фев. 7, 2025
ABSTRACT Transformative service research studies the relationship between provision and well‐being. So far, notion of well‐being applied in this context is mainly directed at specific interventions to improve customer's situation. We propose that should rather be conceptualized from a systemic point view, referring ability system sustain floating equilibrium over time. Social systems theory posits equilibria rely on distinction as basic social operation adapt boundaries revise interactions evolve. Based thought, we study treatment transformative services. identify five different forms need close attention practice design, its external assessment regulation, storytelling about illustrate problems resulting with examples application contexts which are critically discussed. Furthermore, raise variety questions can help gaining better understanding design for customer perspective practice.
Язык: Английский
Процитировано
1
European Journal of Heart Failure, Год журнала: 2025, Номер unknown
Опубликована: Март 17, 2025
Abstract The multiplicity of coexisting comorbidities affecting patients with heart failure ( HF) , together the availability multiple treatments improving prognosis in HF reduced ejection fraction, has led to an increase number prescribed medications each patient. Polypharmacy is defined as regular use medications, and over last years become emerging aspect care, particularly older frailer who are more frequently on treatments, therefore likely exposed tolerability issues, drug–drug interactions practical difficulties management. negatively affects adherence treatment, associated a higher risk adverse drug reactions, impaired quality life, hospitalizations worse prognosis. It important adopt implement strategies for management polypharmacy from other medical disciplines, including medication reconciliation, therapeutic revision treatment prioritization. also essential develop new ‐specific strategies, primary goal avoiding redundant minimizing reactions interactions, finally adherence. This clinical consensus statement document Heart Failure Association European Society Cardiology proposes rationale, pragmatic multidisciplinary approach prescription current era multimorbidity ‘multi‐medication’ .
Язык: Английский
Процитировано
1