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https://www.readbyqxmd.com/read/29467186/a-pilot-study-of-a-medication-rationalization-mera-intervention
#1
Rachel Whitty, Sandra Porter, Kiran Battu, Pranjal Bhatt, Ellen Koo, Csilla Kalocsai, Peter Wu, Kendra Delicaet, Isaac I Bogoch, Robert Wu, James Downar
BACKGROUND: Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications. METHODS: We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity...
February 16, 2018: CMAJ Open
https://www.readbyqxmd.com/read/29453677/changes-in-medicine-prescription-following-a-medication-review-in-older-high-risk-patients-with-polypharmacy
#2
Marian Z M Hurmuz, Sarah I M Janus, Jeannette G van Manen
Background The more (inappropriate) drugs a patient uses, the higher the risk of drug related problems. To reduce these risks, medication reviews can be performed. Objective To report changes in the prescribed number of (potentially inappropriate) drugs before and after performing a medication review in high-risk polypharmacy patients. A secondary objective was to study reasons for continuing potentially inappropriate drugs (PIDs). Setting Dutch community pharmacy and general medical practice. Methods A retrospective longitudinal intervention study with a pre-test/post-test design and follow-up of 1 week and 3 months was performed...
February 17, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29442099/prescribing-or-deprescribing-in-older-persons-what-are-the-real-life-concerns-in-geriatric-practice
#3
Barbara Bień, Katarzyna Bień-Barkowska
INTRODUCTION Multimorbidity in older adults leads to polypharmacy with all its hazardous outcomes and drug related problems. OBJECTIVES We assess the difference in the number of drugs between admission to and discharge from a geriatric ward and identify the patient-related factors associated with changes in the drug regimen. PATIENTS AND METHODS This retrospective cross-sectional study covered 301 geriatric patients who underwent drug optimization in line with the Beers and STOPP/START criteria. The numbers of drugs per individual at hospital admission and discharge were compared using the Wilcoxon signed-rank test...
February 14, 2018: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/29393776/new-media-part-5-online-deprescribing-tools
#4
Elizabeth Phung, Laura Triantafylidis, Haipeng Mark Zhang, Irene M Yeh
No abstract text is available yet for this article.
February 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29382677/computerised-decision-to-reduce-inappropriate-medication-in-the-elderly-a-systematic-review-with-meta-analysis-protocol
#5
Luís Monteiro, Tiago Maricoto, Isabel S Solha, Matilde Monteiro-Soares, Carlos Martins
INTRODUCTION: Life expectancy continues to increase in developed countries. Elderly people are more likely to consume more medications and become vulnerable to age-related changes in drugs' pharmacokinetics and pharmacodynamics. Recent studies have identified opportunities and barriers for deprescribing potentially inappropriate medications. It has already been demonstrated that computerised decision support systems can reduce physician orders for unnecessary tests. We will systematically review the available literature to understand if computerised decision support is effective in reducing the use of potentially inappropriate medications, thus having an impact on health outcomes...
January 30, 2018: BMJ Open
https://www.readbyqxmd.com/read/29361432/research-priorities-for-optimizing-geriatric-pharmacotherapy-an-international-consensus
#6
Edwin C K Tan, Janet K Sluggett, Kristina Johnell, Graziano Onder, Monique Elseviers, Lucas Morin, Davide L Vetrano, Jonas W Wastesson, Johan Fastbom, Heidi Taipale, Antti Tanskanen, J Simon Bell
Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop...
January 17, 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29358245/deprescribing-antipsychotics-for-behavioural-and-psychological-symptoms-of-dementia-and-insomnia-evidence-based-clinical-practice-guideline
#7
REVIEW
Lise M Bjerre, Barbara Farrell, Matthew Hogel, Lyla Graham, Geneviève Lemay, Lisa McCarthy, Lalitha Raman-Wilms, Carlos Rojas-Fernandez, Samir Sinha, Wade Thompson, Vivian Welch, Andrew Wiens
OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS: The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest...
January 2018: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/29355883/optimizing-pain-management-through-opioid-deprescribing
#8
Rachel Lumish, Joshana K Goga, Nicole J Brandt
The use of opioid drug therapy in older adults has increased over the past decade. Although use of opioid drugs may be clinically warranted, ongoing use needs to be monitored closely to evaluate risks and benefits, especially with the potential for adverse events and misuse. An opioid drug deprescribing protocol would provide clinicians with a method to assess an individual's need for opioid agents, as well as a systematic process to taper opioid drug therapy when deemed appropriate. Although more than 60 studies have reported methods for deprescribing, there is currently no established guideline for discontinuing opioid medications...
January 1, 2018: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/29353187/medication-use-in-a-cohort-of-newly-admitted-nursing-home-residents-ageing-nh-in-relation-to-evolving-physical-and-mental-health
#9
Ivana Ivanova, Maarten Wauters, Robert Vander Stichele, Thierry Christiaens, Jonas De Wolf, Tine Dilles, Monique Elseviers
BACKGROUND: Medication use is high among nursing home (NH) residents, but there is a lack of longitudinal studies, determining medication use at admission and its evolution over time. AIM: Describing the evolution of the medication use two years after entering a NH, compared to the baseline observations and exploring the relation to the physical and mental health. METHODS: Data from the observational prospective Ageing@NH study, based on an inception cohort of newly admitted residents at NHs (65+) was used, selecting those consenting and with medication chart available...
January 17, 2018: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/29321031/deprescribing-preventive-cardiovascular-medication-in-patients-with-predicted-low-cardiovascular-disease-risk-in-general-practice-the-ecstatic-study-a-cluster-randomised-non-inferiority-trial
#10
Clare H Luymes, Rosalinde K E Poortvliet, Nan van Geloven, Margot W M de Waal, Yvonne M Drewes, Jeanet W Blom, Nynke Smidt, Willem J J Assendelft, Wilbert B van den Hout, Wouter de Ruijter, Mattijs E Numans
BACKGROUND: The use of cardiovascular medication for the primary prevention of cardiovascular disease (CVD) is potentially inappropriate when potential risks outweigh the potential benefits. It is unknown whether deprescribing preventive cardiovascular medication in patients without a strict indication for such medication is safe and cost-effective in general practice. METHODS: In this pragmatic cluster randomised controlled non-inferiority trial, we recruited 46 general practices in the Netherlands...
January 11, 2018: BMC Medicine
https://www.readbyqxmd.com/read/29274807/deintensification-of-hypoglycaemic-medications-use-of-a-systematic-review-approach-to-highlight-safety-concerns-in-older-people-with-type-2-diabetes
#11
REVIEW
A H Abdelhafiz, A J Sinclair
IMPORTANCE: Intensive treatment of older people with diabetes is common placing them at increased risk of adverse events such as hypoglycaemia and hospitalisation for drug errors. Little is known about when, how or for whom to deintensify hypoglycaemic medications. OBJECTIVE: To explore the characteristics of patients for whom deintensification is appropriate and to determine the outcome of deintensification. EVIDENCE REVIEW: Medline, Google scholar and EmBase search from 1997 to present was performed using keywords relating to diabetes mellitus, polypharmacy, hypoglycaemia, hospitalisation, deintensification, deprescribing and reduction, simplification or withdrawal of hypoglycaemic medications...
November 29, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/29243546/changes-in-medication-use-in-a-cohort-of-patients-with-advanced-cancer-the-international-multicentre-prospective-european-palliative-care-cancer-symptom-study
#12
Kristel Paque, Monique Elseviers, Robert Vander Stichele, Koen Pardon, Marianne J Hjermstad, Stein Kaasa, Tinne Dilles, Martine De Laat, Simon Van Belle, Thierry Christiaens, Luc Deliens
BACKGROUND: Information on medication use in the last months of life is limited. AIM: To describe which medications are prescribed and deprescribed in advanced cancer patients receiving palliative care in relation to time before death and to explore associations with demographic variables. DESIGN: Prospective study, using case report forms for monthly data collection. Medication included cancer treatment and 19 therapeutic groups, grouped into four categories for: (1) cancer therapy, (2) specific cancer-related symptom relief, (3) other symptom relief and (4) long-term prevention...
December 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/29199905/potentially-inappropriate-medication-in-primary-care-at-the-end-of-life-a-mixed-method-study
#13
Peter Pype, Fien Mertens, Fleur Helewaut, Bert D'Hulster, An De Sutter
CONTEXT: Polypharmacy results in adverse drug interactions, high pill burden, and medication costs. Stopping or diminishing potentially inappropriate medication (PIM), is complex . Data on the use of PIM in a primary care context are scarce and deprescribing barriers for general practitioners (GP) are underexplored. OBJECTIVE: Describing the use of PIM in primary care at the end of life, and exploring the barriers for GPs to deprescribe. METHODS: Retrospective chart review of 210 consecutive patients referred to a palliative home care service and semi-structured interviews with 11 GPs...
December 4, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/29190369/decision-making-preferences-and-deprescribing-perspectives-of-older-adults-and-companions-about-their-medicines
#14
Kristie Weir, Brooke Nickel, Vasi Naganathan, Carissa Bonner, Kirsten McCaffery, Stacy M Carter, Andrew McLachlan, Jesse Jansen, Deborah Carr
Objectives: Polypharmacy in the older population is increasing-and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing) but a collaborative approach between patient and doctor is required. This study explores decision-making about polypharmacy with older adults and their companions. Method: Semi-structured interviews were conducted with 30 older people (aged 75+ years, taking multiple medicines) and 15 companions. Framework analysis was used to identify qualitative themes...
November 28, 2017: Journals of Gerontology. Series B, Psychological Sciences and Social Sciences
https://www.readbyqxmd.com/read/29167065/a-systematic-review-of-practice-guidelines-and-recommendations-for-discontinuation-of-cholinesterase-inhibitors-in-dementia
#15
REVIEW
Brenna N Renn, Ali Abbas Asghar-Ali, Stephen Thielke, Angela Catic, Sharyl R Martini, Brian G Mitchell, Mark E Kunik
Cholinesterase inhibitors (ChEIs) are the primary pharmacological treatment for symptom management of Alzheimer disease (AD), but they carry known risks during long-term use, and do not guarantee clinical effects over time. The balance of risks and benefits may warrant discontinuation at different points during the disease course. Indeed, although there is limited scientific study of deprescribing ChEIs, clinicians routinely face practical decisions about whether to continue or stop medications. This review examined published practice recommendations for discontinuation of ChEIs in AD...
February 2018: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29159488/inter-rater-reliability-of-stoppfrail-screening-tool-of-older-persons-prescriptions-in-frail-adults-with-limited-life-expectancy-criteria-amongst-12-physicians
#16
Amanda Hanora Lavan, Paul Gallagher, Denis O'Mahony
PURPOSE: STOPPFrail is an explicit tool, developed by Delphi consensus, to assist physicians with deprescribing medications in frail older adults with poor survival prognosis. This study aimed to determine the inter-rater reliability (IRR), amongst physicians, of STOPPFrail application. METHODS: Twenty clinical cases were collated to represent frail older patients. Eighteen cases met STOPPFrail inclusion criteria. They had a mean age of 79.5 (SD6) years and a median of 7 (IQR6-8...
November 20, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29154017/patient-attitudes-and-experiences-that-predict-medication-discontinuation-in-the-veterans-health-administration
#17
Amy Linsky, Steven R Simon, Kelly Stolzmann, Mark Meterko
OBJECTIVES: Polypharmacy is associated with adverse medication effects. One potential solution is deprescribing, which is the intentional, proactive, rational discontinuation of a medication that is no longer indicated or for which the potential harms outweigh the potential benefits. We identified patient characteristics, attitudes, and health care experiences associated with medication discontinuation. DESIGN, SETTING, AND PARTICIPANTS: We conducted a national mail survey, with the use of the Patient Perceptions of Discontinuation (PPoD) instrument, of 1600 veterans receiving primary care at Veterans Affairs (VA) medical centers and prescribed 5 or more concurrent medications...
January 2018: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/29138153/deprescribing-antihyperglycemic-agents-in-older-persons-evidence-based-clinical-practice-guideline
#18
Barbara Farrell, Cody Black, Wade Thompson, Lisa McCarthy, Carlos Rojas-Fernandez, Heather Lochnan, Salima Shamji, Ross Upshur, Manon Bouchard, Vivian Welch
OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper, stop, or switch antihyperglycemic agents in older adults. METHODS: We focused on the highest level of evidence available and sought input from primary care professionals in guideline development, review, and endorsement processes. Seven clinicians (2 family physicians, 3 pharmacists, 1 nurse practitioner, and 1 endocrinologist) and a methodologist comprised the overall team; members disclosed conflicts of interest...
November 2017: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/29112498/-deprescribing-guiding-its-definition
#19
Aitana Rodríguez-Pérez, Bernardo Santos-Ramos, Eva Rocío Alfaro-Lara
No abstract text is available yet for this article.
November 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/29088989/negotiating-unmeasurable-harm-and-benefit-perspectives-of-general-practitioners-and-consultant-pharmacists-on-deprescribing-in-the-primary-care-setting
#20
Kristen Anderson, Michele Foster, Christopher Freeman, Karen Luetsch, Ian Scott
The use of multiple medicines, known as polypharmacy, poses a risk of harm that is greatest in older adults with multimorbidity. Deprescribing aims to improve health outcomes through ceasing medicines that are no longer necessary or appropriate due to changing clinical circumstances and patient priorities. General practitioners (GPs) and consultant pharmacists (CPs) are well positioned to facilitate deprescribing in primary care in partnership with older adults who present with inappropriate polypharmacy. In this article, we explore GPs' and CPs' views about inappropriate polypharmacy, the reasoning they apply to deprescribing in primary care, and identify factors that support or inhibit this process...
November 2017: Qualitative Health Research
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