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Caroline Sirois, Nicole Ouellet, Emily Reeve
BACKGROUND: While there is evidence that supervised withdrawal of inappropriate medications might be beneficial for individuals with polypharmacy, little is known about their attitudes towards deprescribing. OBJECTIVE: This study aimed to describe the situation among older community-dwelling Canadians. METHODS: A self-administered survey was adapted from the Patients' Attitudes Towards Deprescribing questionnaire and distributed to 10 community pharmacies and 2 community centers...
August 31, 2016: Research in Social & Administrative Pharmacy: RSAP
Gurusamy Sivagnanam
Deprescribing is a structured approach to drug discontinuation. An alternative suggested term is "prescription metabolism." The major aim of deprescription is to purge the drug(s) considered unwanted in a given patient, especially in the elderly patients with multiple comorbidities or in those suffering from chronic disease. Like drug metabolism, prescription metabolism is a way of eliminating unwanted, troublesome, or cost-ineffective medications. The removal of such drugs has been found to decrease the incidence of adverse drug reactions and improves the rate of medication adherence, thereby reducing the economic burden on the patient as well as on the health care providers...
July 2016: Journal of Pharmacology & Pharmacotherapeutics
Ashra Kolhatkar, Lucy Cheng, Fiona K I Chan, Mark Harrison, Michael R Law
OBJECTIVES: Many Canadians use prescription medicines that are unnecessary or that can lead to adverse events. In response, many provinces have introduced programs in which pharmacists are paid to perform medication reviews with patients. As the evidence on such programs is equivocal, we investigated the impact of British Columbia's program. DESIGN: Interrupted time series. SETTING: British Columbia, Canada. PARTICIPANTS: All residents of British Columbia who received a medication review between May 1, 2012, and June 30, 2013 (163,776 individuals)...
September 2016: Journal of the American Pharmacists Association: JAPhA
Amy Linsky, Steven R Simon, Kelly Stolzmann, Mark Meterko
BACKGROUND: Although clinicians ultimately decide when to discontinue (deprescribe) medications, patients' perspectives may guide the process. OBJECTIVES: To develop a survey instrument that assesses patients' experience with and attitudes toward deprescribing. RESEARCH DESIGN: We developed a questionnaire with established and newly created items. We used exploratory factor analysis and confirmatory factor analysis (EFA and CFA) to assess the psychometric properties...
August 30, 2016: Medical Care
Arritxu Etxeberria, Josune Iribar, Javier Hernando, Ignacia Idarreta, Itziar Vergara, Carmela Mozo, Kalliopi Vrotsou, Joaquín Belzunegui, Arantxa Lekuona
OBJECTIVE: To evaluate the impact of a multifactorial intervention to promote bisphosphonate deprescription after over 5 years of use (BF5y) in a health care organisation (HCO) in Gipuzkoa (Spain) and to compare it with the standard intervention in other HCOs in the Basque Health Service-Osakidetza. METHODS: An 8-month follow-up study (results from before and after) to assess the impact of two interventions. All patients from Osakidetza receiving BF5y treatment (electronic prescription) in July 2013 were included...
August 24, 2016: Gaceta Sanitaria
Barbara Farrell, Kevin Pottie, Carlos H Rojas-Fernandez, Lise M Bjerre, Wade Thompson, Vivian Welch
BACKGROUND: 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 to create such guidelines using evidence-based methods for guideline development, evidence synthesis and recommendation rating. METHODS AND FINDINGS: Using a comprehensive checklist for a successful guideline enterprise, we conducted a national modified Delphi consensus process to identify priorities for deprescribing guidelines, then conducted scoping exercises to identify feasible topics, and sequentially developed three deprescribing guidelines...
2016: PloS One
Manvi Sharma, Kah Poh Loh, Ginah Nightingale, Supriya G Mohile, Holly M Holmes
Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer...
September 2016: Journal of Geriatric Oncology
Kate Walsh, Debbie Kwan, Patricia Marr, Christine Papoushek, W Kirk Lyon
BACKGROUND Proton pump inhibitors (PPIs) are often used inappropriately, without an indication, or for longer durations than recommended. Few tools exist to guide reassessment of their continued use and deprescribing if required. We aimed to reduce inappropriate drug use by developing and implementing a PPI deprescribing tool and process in a family medicine unit. ASSESSMENT OF PROBLEM Primary care providers of adults taking a PPI for 8 weeks with an upcoming periodic health examination were reminded to reassess therapy via electronic medical record (EMR) messaging...
June 2016: Journal of Primary Health Care
Amy Theresa Page, Kathleen Potter, Rhonda Clifford, Christopher Etherton-Beer
Older people with chronic disease have great potential to benefit from their medications but are also at high risk of harm from their medications. The use of medications is particularly important for symptom control and disease progression in older people. Under-treatment means older people can miss out on the potential benefits of useful medications, while over-treatment (polypharmacy) puts them at increased risk of harm. Deprescribing attempts to balance the potential for benefit and harm by systematically withdrawing inappropriate medications with the goal of managing polypharmacy and improving outcomes...
September 2016: Maturitas
Kaisu H Pitkälä, Merja H Suominen, J Simon Bell, Timo E Strandberg
Evidence for the safety and effectiveness of dietary supplements is mixed. The extent to which older people use dietary supplements concomitantly with conventional medications is often under-appreciated by physicians. We conducted a literature review on clinical considerations associated with dietary supplement use, focusing on benefits and harms, motivations for use and contribution to polypharmacy among older people. Vitamin D ≥ 800 IU has demonstrated benefits in fracture prevention. Vitamins A, E, and β-carotene have been associated with an increase in total mortality in several meta-analyses...
July 16, 2016: Annals of Medicine
Emily Reeve, Petra Denig, Sarah N Hilmer, Ruud Ter Meulen
Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics (beneficence, non-maleficence, autonomy, and justice) that may guide medical practitioners' prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to deprescribing...
July 14, 2016: Journal of Bioethical Inquiry
Natali Jokanovic, Kate N Wang, Michael J Dooley, Samanta Lalic, Edwin Ck Tan, Carl M Kirkpatrick, J Simon Bell
BACKGROUND: Polypharmacy is highly prevalent in residential aged care facilities (RACFs). Although polypharmacy is sometimes unavoidable, polypharmacy has been associated with increased morbidity and mortality. OBJECTIVE: To identify and prioritize a range of potential interventions to manage polypharmacy in RACFs from the perspectives of health care professionals, health policy and consumer representatives. METHODS: Two nominal group technique (NGT) sessions were convened in August 2015...
June 15, 2016: Research in Social & Administrative Pharmacy: RSAP
Efraim Aizen, Eman Hindawil, Mohammed Hijazi, Atef Merih, Hatim Shahla, Ahmad Abu Elyounes
INTRODUCTION: Polypharmacy, inappropriate prescribing and adverse drug reactions are frequent and important among elderly nursing home residents. Few clinical trials have evaluated systematic withdrawal of medications in nursing homes. OBJECTIVES: To compare the effect of a controlled deprescribing intervention against the usual care in elderly nursing home residents. METHODS: The present deprescribing intervention was conducted in two departments at the Shfaram Geriatric Center (Beet Alenaya)...
March 2016: Harefuah
Wade Thompson, Matthew Hogel, Yan Li, Kednapa Thavorn, Denis O'Donnell, Lisa McCarthy, Lisa Dolovich, Cody Black, Barbara Farrell
OBJECTIVES: To assess the effect of a proton pump inhibitor (PPI) deprescribing guideline on PPI usage and PPI drug costs in one long-term care home in Ontario, Canada. DESIGN: Interrupted time-series analysis to compare monthly PPI usage and average monthly PPI cost per resident 9 months before guideline implementation to 12 months after. SETTING: One long-term care home in Ottawa, Ontario, Canada. PARTICIPANTS: Long-term care residents prescribed a PPI over a 21-month period (n = 335)...
July 1, 2016: Journal of the American Medical Directors Association
(no author information available yet)
Multimorbidity and associated polypharmacy present a significant and increasing challenge to patients, carers and healthcare professionals.(1,2) While it is recognised that polypharmacy can be beneficial, there is considerable potential for harm, particularly through drug interactions, adverse drug events and non-adherence.(1) Such harms are amplified in people who are frail and who may require interventions to be tailored to their individual needs rather than strictly following guidance designed to manage single diseases...
June 2016: Drug and Therapeutics Bulletin
Emily Reeve, Lee-Fay Low, Sarah N Hilmer
BACKGROUND: Deprescribing describes the complex process that is required for the safe and effective cessation of medications that are likely to cause more harm than benefit. Knowledgeof older adults' and carers' attitudes towards deprescribing will enhance shared decision making in medication optimisation. AIM: To explore the views, beliefs, and attitudes of older adults and carers on deprescribing. DESIGN AND SETTING: Qualitative focus group study in New South Wales, Australia...
August 2016: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Nina M Bemben
Polypharmacy has been found to have potentially negative consequences for patients due to use of potentially inappropriate medications, as well as increased risk of drug interactions and adverse effects. Deprescribing has been proposed as a method of improving medication use throughout a patient's course of care. This article reviews the process of deprescribing and applies the process to medication classes commonly encountered by clinical pharmacists. This review of therapeutics included studies identified through a PubMed search and by review of the reference list of included studies...
July 2016: Pharmacotherapy
Jesse Jansen, Vasi Naganathan, Stacy M Carter, Andrew J McLachlan, Brooke Nickel, Les Irwig, Carissa Bonner, Jenny Doust, Jim Colvin, Aine Heaney, Robin Turner, Kirsten McCaffery
No abstract text is available yet for this article.
2016: BMJ: British Medical Journal
Lisa Kouladjian, Danijela Gnjidic, Emily Reeve, Timothy F Chen, Sarah N Hilmer
BACKGROUND: Anticholinergic and sedative (ACh-Sed) medications are commonly prescribed for older adults and are associated with adverse events. OBJECTIVES: (1) To investigate perspectives of health care practitioners (HCPs) surrounding deprescribing (withdrawal) of ACh-Sed medications in older adults; (2) to assess HCPs' perspectives on the design and implementation of a report on a patient's exposure to ACh-Sed medications using the Drug Burden Index (DBI) pharmacological tool...
August 2016: Annals of Pharmacotherapy
Domenica Disalvo, Tim Luckett, Meera Agar, Alexandra Bennett, Patricia Mary Davidson
BACKGROUND: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia. METHODS: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care...
2016: BMC Geriatrics
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