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Polypharmacy and deprescribing

Adam Todd, Jesse Jansen, Jim Colvin, Andrew J McLachlan
The area of "deprescribing" has rapidly expanded in recent years as a positive intervention to reduce inappropriate polypharmacy and improve health outcomes for (older) people with multimorbidity. While our understanding of deprescribing as a process has greatly improved and existing approaches all have patient-centered elements, there is still limited literature exploring the importance of the individual patient context in deprescribing decision-making. This is clearly an important consideration to ensure that any deprescribing approach is ethical, respectful, and successful...
November 29, 2018: BMC Geriatrics
Justin P Turner, Janet Currie, Johanna Trimble, Cara Tannenbaum
Many seniors remain unaware that certain medications may be harmful, despite high rates of polypharmacy and inappropriate medication use among community-dwelling older adults. Patient education is an effective method for reducing the use of inappropriate medications. Increasing public awareness and engagement is essential for promoting shared decision-making to deprescribe. The Canadian Deprescribing Network was created to address the lack of a systematic pan-Canadian initiative to implement deprescribing among older Canadians...
November 2018: Therapeutic Advances in Drug Safety
Rachel Edey, Nicholas Edwards, Jonah Von Sychowski, Ajay Bains, Jim Spence, Dan Martinusen
Background Successful deprescribing practices are required to address issues associated with polypharmacy but are hindered by minimal interprofessional collaboration, time constraints, concern for negative outcomes, and absence of a systematic and evidence-based approach. Objective Determine the impact of pharmacist-led deprescribing rounds within a clinical teaching unit (CTU) the number of home medications discontinued upon hospital discharge. Setting Canadian tertiary care hospital. Methods Prospective, dual-arm, interventional study conducted in a single centre, from November 23rd, 2015 to August 30th, 2016...
November 27, 2018: International Journal of Clinical Pharmacy
Robyn Gillespie, Judy Mullan, Lindsey Harrison
Polypharmacy is increasing among older Australians, raising their risk of experiencing medication-related harm. As part of the prescribing continuum, deprescribing is a strategy proposed to reduce inappropriate polypharmacy. This study explored factors that influence deprescribing among Australian GPs using a new 21-item survey to measure GP attitudes and practices. The 85 GP responses indicated that many factors are supportive of deprescribing. GPs suggest that they are willing to explore their older patients' deprescribing preferences; they believe that they have enough information about the potential harms and benefits of medication to inform their deprescribing decisions and are confident to communicate this information to their patients...
November 14, 2018: Australian Journal of Primary Health
Michaela L Schiøtz, Anne Frølich, Anette K Jensen, Lene Reuther, Hans Perrild, Tonny S Petersen, Jonatan Kornholt, Mikkel B Christensen
Polypharmacy is common among multimorbid adults and associated with increased morbidity and mortality. Excessive polypharmacy (ie, ≥10 medicine) is strongly associated with inappropriate medication use, but little is known about attitudes toward deprescribing in patients with excessive polypharmacy. We surveyed 100 Danish individuals aged 65 years and above with ≥10 prescribed medications, using the validated Patients' Attitudes Towards Deprescribing (PATD) instrument. Most participants (81, 81%) thought they took a large number of medications, and 79 (79%) believed that their medications were necessary...
December 2018: Pharmacology Research & Perspectives
Sophie Mantelli, Katharina Tabea Jungo, Zsofia Rozsnyai, Emily Reeve, Clare H Luymes, Rosalinde K E Poortvliet, Arnaud Chiolero, Nicolas Rodondi, Jacobijn Gussekloo, Sven Streit
BACKGROUND: Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population. METHODS: GPs took an online survey that presented case-vignettes of a frail oldest-old patient with and without history of cardiovascular disease (CVD) and asked if they would deprescribe any of seven medications...
October 12, 2018: BMC Family Practice
James P Sheppard, Jenni Burt, Mark Lown, Eleanor Temple, John Benson, Gary A Ford, Carl Heneghan, F D Richard Hobbs, Sue Jowett, Paul Little, Jonathan Mant, Jill Mollison, Alecia Nickless, Emma Ogburn, Rupert Payne, Marney Williams, Ly-Mee Yu, Richard J McManus
INTRODUCTION: Recent evidence suggests that larger blood pressure reductions and multiple antihypertensive drugs may be harmful in older people, particularly frail individuals with polypharmacy and multimorbidity. However, there is a lack of evidence to support deprescribing of antihypertensives, which limits the practice of medication reduction in routine clinical care. The aim of this trial is to examine whether antihypertensive medication reduction is possible in older patients without significant changes in blood pressure control at follow-up...
October 4, 2018: BMJ Open
Laura K Triantafylidis, Chelsea E Hawley, Laura P Perry, Julie M Paik
Older adults with chronic kidney disease (CKD) often experience polypharmacy, a recognized predictor of prescribing problems including inappropriately dosed medications, drug-drug and drug-disease interactions, morbidity and mortality. Polypharmacy is also associated with nonadherence, which leads to recurrent hospitalizations and poorer hemodialysis outcomes in CKD patients. Further complicating medication management in this vulnerable population are the physiologic changes that occur with both age and CKD...
November 2018: Drugs & Aging
Óscar Esteban Jiménez, María Pilar Arroyo Aniés, Caterina Vicens Caldentey, Francisca González Rubio, Miguel Ángel Hernández Rodríguez, Mara Sempere Manuel
The increasing longevity of the population, the increase in morbidity and the consumption of medications have caused that polypharmacy is a priority health problem due to its consequences: increase of adverse effects, pharmacological interactions and favor the functional deterioration of the patient. The clinical situation of the patients changes over time and it is necessary to adjust the medication in each stage, assessing the fragility, the level of dependence and the functional deterioration. Deprescription is complex and requires an adequate clinical and pharmacological formation...
September 29, 2018: Atencion Primaria
Sioe Lie Thio, Joana Nam, Mieke L van Driel, Thomas Dirven, Jeanet W Blom
BACKGROUND: Polypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this. AIM: To examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes. DESIGN AND SETTING: This systematic review included randomised controlled trials published in 2005-2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing...
October 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Barbara Farrell, James Conklin, Lisa Dolovich, Hannah Irving, Malcolm Maclure, Lisa McCarthy, Frank Moriarty, Kevin Pottie, Lalitha Raman-Wilms, Emily Reeve, Wade Thompson
Deprescribing is a clinically important and feasible innovation that ensures medication efficacy, reduces harms, and mitigates polypharmacy. It involves reducing doses or stopping medications that are not useful, no longer needed, or which may be causing harm. It may also involve changing to a safer agent or using non-pharmacological approaches for care instead. Clinical guidelines combined with behaviour changes (of health care providers (HCPs), the public, and health care decision-makers) are needed to integrate deprescribing into routine practice...
September 18, 2018: Research in Social & Administrative Pharmacy: RSAP
M S Salahudeen
In the aging population, the process of medication prescribing and management is likely to be complex and challenging. Polypharmacy and inappropriate medication use are more prevalent among older people and are associated with geriatric syndromes, reduced cognitive and functional outcomes, and increased mortality. Deprescribing is the process of planned and supervised tapering or safe withdrawal of potentially inappropriate medication that can cause harm, or is no longer indicated or beneficial to the current therapy...
August 2018: Drugs of Today
Alec W Petersen, Avantika S Shah, Sandra F Simmons, Matthew S Shotwell, J Mary Lou Jacobsen, Amy P Myers, Amanda S Mixon, Susan P Bell, Sunil Kripalani, John F Schnelle, Eduard E Vasilevskis
Background: Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. Methods: This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications...
September 2018: Therapeutic Advances in Drug Safety
Pier Mannuccio Mannucci, Alessandro Nobili, Emanuela Marchesini, Emily Oliovecchio, Laura Cortesi, Antonio Coppola, Elena Santagostino, Paolo Radossi, Giancarlo Castaman, Lelia Valdrè, Cristina Santoro, Annarita Tagliaferri, Cosimo Ettorre, Ezio Zanon, Giovanni Barillari, Isabella Cantori, Teresa Maria Caimi, Gianluca Sottilotta, Flora Peyvandi, Alfonso Iorio
BACKGROUND: In older people, multiple chronic ailments lead to the intake of multiple medications (polypharmacy) that carry a number of negative consequences (adverse events, prescription and intake errors, poor adherence, higher mortality). Because ageing patients with haemophilia (PWHs) may be particularly at risk due to their pre-existing multiple comorbidities (arthropathy, liver disease), we chose to analyse the pattern of chronic drug intake in a cohort of PWHs aged 60 years or more...
September 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
Majed Alshamrani, Abdullah Almalki, Mohamed Qureshi, Oyindamola Yusuf, Sherine Ismail
Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period...
July 25, 2018: Pharmacy (Basel, Switzerland)
Pedro Augusto Simões, Luiz Miguel Santiago, José Augusto Simões
INTRODUCTION: Polypharmacy is commonly defined as the simultaneous taking of five or more drugs. Deprescribing is the process of tapering or stopping medications with the aim of improving patient outcomes and optimising current therapy, and there are several tools aiming at identifying potentially inappropriate medications, especially in the elderly. The direct involvement of patients and their caregivers in the choice and administration of drugs has long been known to be very important, but it is not usually applied...
July 17, 2018: BMJ Open
Karen Cardwell, B Clyne, F Moriarty, E Wallace, T Fahey, F Boland, L McCullagh, S Clarke, K Finnigan, M Daly, M Barry, S M Smith
Background: Prescribing for patients taking multiple medicines (i.e. polypharmacy) is challenging for general practitioners (GPs). Limited evidence suggests that the integration of pharmacists into the general practice team could improve the management of these patients. The aim of this study is to develop and test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system. Methods: This non-randomised pilot study will use a mixed-methods approach...
2018: Pilot and Feasibility Studies
Anja Rieckert, Christina Sommerauer, Anja Krumeich, Andreas Sönnichsen
BACKGROUND: Within the EU-funded project PRIMA-eDS (Polypharmacy in chronic diseases: Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support) an electronic decision support tool (the "PRIMA-eDS-tool") was developed for general practitioners (GPs) to reduce inappropriate medication in their older polypharmacy patients. After entering patient data relevant to prescribing in an electronic case report form the physician received a comprehensive medication review (CMR) on his/her screen displaying recommendations regarding missing indications, necessary laboratory tests, evidence-base of current medication, dose adjustments for renal malfunction, potentially harmful drug-drug interactions, contra-indications, and possible adverse drug events...
July 9, 2018: BMC Family Practice
Barbara Resnick, Elizabeth Galik, Marie Boltz, Sarah Holmes, Steven Fix, Erin Vigne, Shijun Zhu, Regina Lewis
OBJECTIVE: The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations. DESIGN: This was a descriptive study using data from a larger study testing the Dissemination and Implementation of Function Focused Care for Assisted Living (FFC-AL-EIT)...
June 1, 2018: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Andrew Whitman, Kathlene DeGregory, Amy Morris, Supriya Mohile, Erika Ramsdale
PURPOSE: The aims of this study were to compare the application of three geriatric medication screening tools to the Beers Criteria alone for potentially inappropriate medication quantification and to determine feasibility of a pharmacist-led polypharmacy assessment in a geriatric oncology clinic. METHODS: Adult patients with cancer aged 65 and older underwent a comprehensive geriatric assessment. A polypharmacy assessment was completed by a pharmacist and included a review of all drug therapies...
December 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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