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Deprescribing

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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
#1
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
#2
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
#3
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
#4
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...
October 10, 2017: 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
#5
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
#6
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...
November 16, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/29138153/deprescribing-antihyperglycemic-agents-in-older-persons-evidence-based-clinical-practice-guideline
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/29072544/a-narrative-review-of-the-safety-concerns-of-deprescribing-in-older-adults-and-strategies-to-mitigate-potential-harms
#10
Emily Reeve, Frank Moriarty, Rayan Nahas, Justin P Turner, Lisa Kouladjian O'Donnell, Sarah N Hilmer
As with prescribing or continuing medications, deprescribing brings with it the potential for harm as well as benefit. Uncertainty and avoidance of harm has been reported as a barrier to deprescribing in practice and may contribute to continuation of inappropriate medications. Areas covered: This narrative review covers four main safety concerns/potential harms of deprescribing in older adults: adverse drug withdrawal events, return of medical condition(s), reversal of drug-drug interactions and damage to the doctor-patient relationship...
October 26, 2017: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/29055352/deprescribing-in-ckd-the-proof-is-in-the-process
#11
EDITORIAL
Chanel F Whittaker, Jeffrey C Fink
No abstract text is available yet for this article.
November 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29052715/meaningful-deprescribing-in-the-nursing-home
#12
Holly M Holmes, Greg A Sachs
No abstract text is available yet for this article.
October 10, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29029668/the-de-pharm-project-a-pharmacist-driven-deprescribing-initiative-in-a-nursing-facility
#13
Jennifer Pruskowski, Steven M Handler
OBJECTIVE: Many residents with life-limiting illnesses are being prescribed and taking potentially inappropriate medications (PIMs) and questionably beneficial medications either near or at the end of life. These medications can contribute to adverse drug reactions, increase morbidity, and increase unnecessary burden and cost. It is crucial that the process of deprescribing be incorporated into the care of these residents. After developing a clinical pharmacist-driven deprescribing initiative in the nursing facility, the objective of this project was to reduce the number of PIMs via accepted recommendations from the clinical pharmacist to the primary team...
August 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29016367/updates-in-nutrition-and-polypharmacy
#14
Milta O Little
PURPOSE OF REVIEW: Medications have the potential to affect nutritional status in negative ways, especially as the number of medications increase. The inter-relation between polypharmacy and malnutrition is complex and not fully delineated in previous studies. More research has been done and compiled in the last year, which helps to clarify this relationship. This review brings together the most recent literature with the previous research to help healthcare providers to better assess and manage medication therapy in older adults...
October 7, 2017: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/28951110/n-of-1-trials-for-assessing-the-effects-of-deprescribing-medications-on-short-term-clinical-outcomes-in-older-adults-a-systematic-review
#15
REVIEW
Alexander J Clough, Sarah N Hilmer, Sharon L Naismith, Luke D Kardell, Danijela Gnjidic
OBJECTIVES: The objective of this study was to determine the applicability of utilizing the N-of-1 method for deprescribing trials in older adults. STUDY DESIGN AND SETTING: Systematic review of any human studies conducted in older adults (≥50 years), deprescribing any long-term treatment over less than a year using the N-of-1 trial method was performed. Two authors independently reviewed all articles for eligibility and extracted data. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
September 22, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28945453/de-prescription
#16
Diane Portman
Deprescribing is the removal or reduction of medications to improve patient function and quality of life. Despite potential benefits, patients who have received medications from trusted clinicians may resist deprescription, as they fear return of medical problems, use medications to cope, or view them as instruments to benefit health or prolong life. Deprescribing clinicians often struggle with opposition and patient distress as they seek to enhance patient well-being. (PsycINFO Database Record
September 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28945268/do-residents-need-all-their-medications-a-cross-sectional-survey-of-rns-views-on-deprescribing-and-the-role-of-clinical-pharmacists
#17
Nagham Ailabouni, June Tordoff, Dee Mangin, Prasad S Nishtala
A cross-sectional survey was mailed to 307 RNs of a nationally representative sample of residential aged care facilities to investigate their views and perceptions on medication use and deprescribing in older adults. Questions were grouped according to each stage of the medication use process, and a dedicated section to explore nurses' views on deprescribing was included. Ninety-one questionnaires were received, yielding a 29.6% response rate. Respondents highlighted several challenges including achieving medication reconciliation for new residents, access to physicians to admit patients in a timely fashion, and issues pertaining to lack of clear medical information transcribing when transferring patients between health care settings...
October 1, 2017: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/28927372/potentially-inappropriate-medication-use-in-nursing-homes-an-observational-study-using-the-norgep-nh-criteria
#18
Gunhild Nyborg, Mette Brekke, Jørund Straand, Svein Gjelstad, Maria Romøren
BACKGROUND: Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. METHODS: Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway...
September 19, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28913911/older-adults-awareness-of-deprescribing-a-population-based-survey
#19
Justin P Turner, Cara Tannenbaum
OBJECTIVES: To determine older adults' awareness of the concept of medication-induced harm and their familiarity with the term "deprescribing." Secondary objectives were to ascertain determinants of self-initiated deprescribing conversations and to identify how older adults seek information on medication harms. DESIGN: Cross-sectional population-based household telephone survey using random-digit dialling. SETTING: Canada. PARTICIPANTS: Community-dwelling adults aged 65 and older (N = 2,665; n = 898 men, n = 1,767 women, mean age 74...
September 15, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28895169/we-have-had-a-gutful-the-need-for-deprescribing-proton-pump-inhibitors
#20
M Naunton, G M Peterson, L S Deeks, H Young, S Kosari
WHAT IS KNOWN AND OBJECTIVE: Proton pump inhibitor (PPI) prescribing may often be inappropriate and expose patients to a risk of adverse effects, while incurring unnecessary healthcare expenditure. Our objective was to determine PPI usage in Australia since 2002 and review international studies investigating inappropriate PPI prescribing, including those that discussed interventions to address this issue. METHODS: Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) data were analysed...
September 11, 2017: Journal of Clinical Pharmacy and Therapeutics
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