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https://www.readbyqxmd.com/read/29678989/prescribing-and-deprescribing-antihypertensive-medication-in-older-people-by-dutch-general-practitioners-a-qualitative-study
#1
Tessa van Middelaar, Sophie D Ivens, Petra G van Peet, Rosalinde K E Poortvliet, Edo Richard, A Jeannette Pols, Eric P Moll van Charante
OBJECTIVES: To explore general practitioners' (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support. DESIGN: Semistructured interviews. SETTING: Dutch general practice. PARTICIPANTS: Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29659552/improving-pharmacists-targeting-of-patients-for-medication-review-and-deprescription
#2
Vanessa Marvin, Emily Ward, Barry Jubraj, Mark Bower, Iñaki Bovill
Background: In an acute hospital setting, a multi-disciplinary approach to medication review can improve prescribing and medicine selection in patients with frailty. There is a need for a clear understanding of the roles and responsibilities of pharmacists to ensure that interventions have the greatest impact on patient care. Aim: To use a consensus building process to produce guidance for pharmacists to support the identification of patients at risk from their medicines, and to articulate expected actions and escalation processes...
April 16, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29642377/benzodiazepines-withdrawal-initial-outcomes-and-long-term-impact-on-falls-in-a-french-nursing-home
#3
Hervé Javelot, Anne Marquis, Emilie Antoine-Bernard, Jean Grandidier, Luisa Weiner, Thierry Javelot, Bruno Michel
Long-term use of benzodiazepines (BZDs) is known to induce tolerance and dependence, and increase the risk of falls-related injuries in older adults. We present a study carried out in a French nursing home that concerns the implementation of a BZD withdrawal program reassessed at one year. BZD deprescription was achieved by gradual cessation of doses. A secondary benefit of this program was assessed by comparing the number of falls among residents before and after withdrawal. The number of falls was recorded over a six-month period prior to the onset of withdrawal (T1) and then over a six-month period after reassessment at one year (T2)...
April 6, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29493631/-some-considerations-about-adherence-to-therapy
#4
Maria Font
Poor adherence to therapy is a proven cause of therapeutic failure, transversal to all areas of medicine with broad health and economic repercussions. There are many factors that can lead to inadequate adherence, currently also economic reasons. The evidence available from the intervention studies implemented to improve adherence in various clinical conditions offers disappointing results, particularly in chronic conditions where the interventions implemented were found to be complex and relatively ineffective...
February 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29473423/implementation-of-proton-pump-inhibitor-deprescription-protocol-in-geriatric-residents
#5
Ovadyah Avraham, Michael Biglow
BACKGROUND: Deprescribing is a recommended intervention to reduce morbidity and mortality caused by polypharmacy in older residents. However, a lack of definite deprescription guidelines and evidence of clinically meaningful outcomes complicates or precludes the practicality of such an approach. OBJECTIVE: The objective of the present pilot study is to establish and implement a stepwise taper protocol that can potentially minimize overuse of proton pump inhibitors in a safe, effective, and feasible manner in the nursing home...
February 1, 2018: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/29339434/cerebrovascular-outcomes-with-proton-pump-inhibitors-and-thienopyridines-a-systematic-review-and-meta-analysis
#6
REVIEW
Konark Malhotra, Aristeidis H Katsanos, Mohammad Bilal, Muhammad Fawad Ishfaq, Nitin Goyal, Georgios Tsivgoulis
BACKGROUND AND PURPOSE: Pharmacokinetic and prior studies on thienopyridine and proton pump inhibitors (PPI) coadministration provide conflicting data for cardiovascular outcomes, whereas there is no established evidence on the association of concomitant use of PPI and thienopyridines with adverse cerebrovascular outcomes. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials and cohort studies from inception to July 2017, reporting following outcomes among patients treated with thienopyridine and PPI versus thienopyridine alone (1) ischemic stroke, (2) combined ischemic or hemorrhagic stroke, (3) composite outcome of stroke, myocardial infarction (MI), and cardiovascular death, (4) MI, (5) all-cause mortality, and (6) major or minor bleeding events...
February 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29221946/-facing-a-dilemma-in-elderly-complex-and-vulnerable-patients-to-stop-or-not-to-stop-prevention
#7
Laura Llobet Vila, Josep Maria Manresa Domínguez, José Manuel Carmona Segado, Alícia Franzi Sisó, Rosa Vallès Balasch, Isabel Martínez Díaz
OBJECTIVES: 1-To know the preventive prescription (statin, antiplatelet drugs, bisphosphonates, calcium and vitamin D and Vit B12) of elderly patients previously identified as a CCD (with a complex chronic disease) and ACD (with advanced chronic disease and lifetime expectancy of less than 12 months) who died during 2015. 2-To assess the correct indication of Proton Pump Inhibitors (PPI) to determine potentially avoidable medication. DESIGN: Retrospective observational study...
December 5, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28945453/de-prescription
#8
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/28867334/antihypertensive-overtreatment-in-people-80-years-old-and-older
#9
José Miguel Baena Díez, Nerea López Maldonado, Elena Navarro Guiu, Daniel Alcayde Claveria, Manel García Lareo, Almudena Pérez Orcero
BACKGROUND AND OBJECTIVE: To study the proportion of patients older than 80 years old with hypertension and pharmacological overtreatment. PATIENTS AND METHODS: Cross-sectional simulation study, including 281 patients older than 80 years old of primary prevention, randomly selected, with good control of hypertension (systolic blood pressure<150mmHg, diastolic blood pressure<90mmHg), treated with a maximum of 3 medications. Overtreatment was considered if at least one medication could be removed and good control persisted, calculating how the blood pressure would raise with Law's meta-analysis, which estimates blood pressure reductions by pre-treatment levels, number and dose of medications...
March 23, 2018: Medicina Clínica
https://www.readbyqxmd.com/read/28805170/perspectives-of-patients-close-relatives-nurses-and-physicians-on-end-of-life-medication-management
#10
Marianne K Dees, Eric C T Geijteman, Wim J M Dekkers, Bregje A A Huisman, Roberto S G M Perez, Lia van Zuylen, Agnes van der Heide, Evert van Leeuwen
OBJECTIVE: Our aim was to gain insight into the perspectives of patients, close relatives, nurses, and physicians on medication management for patients with a life expectancy of less than 3 months. METHOD: We conducted an empirical multicenter study with a qualitative approach, including in-depth interviews with patients, relatives, nurses, specialists, and general practitioners (GPs). We used the constant comparative method and ATLAS.ti (v. 7.1) software for our analysis...
August 14, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28683712/-deprescription-what-are-we-talking-about
#11
Marta Gutiérrez-Valencia, Nicolás Martínez-Velilla
No abstract text is available yet for this article.
July 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/28579760/understanding-deprescribing-of-preventive-cardiovascular-medication-a-q-methodology-study-in-patients
#12
Clare H Luymes, Nelleke J Boelhouwer, Rosalinde Ke Poortvliet, Wouter de Ruijter, Ria Reis, Mattijs E Numans
BACKGROUND: Patients with low cardiovascular disease (CVD) risk potentially use preventive cardiovascular medication unnecessarily. Our aim was to identify various viewpoints and beliefs concerning the preventive CVD management of patients with low CVD risk using preventive cardiovascular medication. Furthermore, we investigated whether certain viewpoints were related to a preference for deprescription or the continuation of preventive cardiovascular medication. METHODS: In 2015, we purposively sampled patients from the intervention arm of the Evaluating Cessation of STatins and Antihypertensive Treatment In primary Care (ECSTATIC) trial in the Netherlands for this study...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28475657/missed-opportunities-for-deprescription-a-teachable-moment
#13
Ismail A Raslan, Emily G McDonald, Todd C Lee
No abstract text is available yet for this article.
July 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28416321/targeted-deprescribing-in-an-outpatient-hemodialysis-unit-a%C3%A2-quality-improvement-study-to-decrease-polypharmacy
#14
Caitlin McIntyre, Rory McQuillan, Chaim Bell, Marisa Battistella
BACKGROUND: Polypharmacy in hemodialysis patients can result in adverse patient outcomes. Deprescribing tools can reduce polypharmacy, yet no method exists for an outpatient hemodialysis population. DESIGN: Quality improvement study. SETTING & PARTICIPANTS: 240 patients in a tertiary-care outpatient hemodialysis unit. QUALITY IMPROVEMENT PLAN: We aimed to: (1) develop a deprescribing tool for target medications with poor evidence for efficacy and safety, (2) determine its effectiveness in decreasing polypharmacy, and (3) monitor patient safety and satisfaction...
November 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28224957/-medicines-and-elderly-patients-abuse-dependency-or-attraction
#15
Pascal Menecier, Laure Menecier-Ossia
Psychotropic medicines represent, after alcohol, the second class of substances most susceptible to abuse by elderly people. It can be particularly difficult for caregivers to understand such behaviour as these are prescription-only medicines. This misuse is partly a result of older people tending to trivialise and overrate pharmaceutical drugs, ignoring the potential of non-medicinal methods and psychotherapeutic treatments. The boundaries between prescribed use, overuse, self-medication, excessive use, dependency or addiction to prescription drugs are blurred in older people...
January 2017: Soins. Gérontologie
https://www.readbyqxmd.com/read/28215652/polypathology-polypharmacy-medication-regimen-complexity-and-drug-therapy-appropriateness
#16
N Gómez Aguirre, A Caudevilla Martínez, L Bellostas Muñoz, M Crespo Avellana, J Velilla Marco, J Díez-Manglano
Polypathological patients are usually elderly and take numerous drugs. Polypharmacy affects 85% of these individuals and is not associated with greater survival. On the contrary, polypharmacy exposes these individuals to more adverse effects, such as weight loss, falls, functional and cognitive impairment and hospitalisations. The complexity of a drug regimen covers more aspects than the simple number of drugs consumed. The galenic form, the dosage and the method for preparing the drug can impede the understanding of and compliance with prescriptions...
June 2017: Revista Clínica Española
https://www.readbyqxmd.com/read/27651709/deprescription-the-prescription-metabolism
#17
REVIEW
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
https://www.readbyqxmd.com/read/27570993/is-there-an-overprescription-of-proton-pump-inhibitors-in-oncohematologic-patients-undergoing-ambulatory-oncospecific-treatment
#18
Meritxell Pujal Herranz
OBJECTIVE: The aim of this study is to evaluate the prevalence of proton pump inhibitors (PPIs) prescription, and the level of adequacy of the indication of these drugs in oncohematologic patients under ambulatory oncoespecific treatment. METHOD: An observational descriptive study in oncohematologic patients under ambulatory oncoespecific treatment. A protocol for the rational use of PPI targeted to oncohematologic patients based on the PPI protocol of our hospital was designed...
September 1, 2016: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/27568171/-deprescribing-long-term-treatments-with-bisphosphonates-for-osteoporosis-in-primary-care-in-the-basque-country-spain
#19
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...
January 2017: Gaceta Sanitaria
https://www.readbyqxmd.com/read/27491473/deprescription-in-advanced-cancer-patients-referred-to-palliative-care
#20
Liliana Oliveira, Marta Oliveira Ferreira, Alexandre Rola, Miguel Magalhães, José Ferraz Gonçalves
In palliative care, drugs are considered futile if they do not have a short-term benefit in symptom control or quality of life. The authors examined pharmacotherapy prescribed for patients referred to palliative care to identify futile drugs. This was a retrospective analysis of patients referred over 6 months, focusing on the prescription of gastric protectants, antidiabetic agents, bisphosphonates, anticoagulants, antidementia drugs, statins, and antihypertensive agents. The sample consisted of 448 patients...
September 2016: Journal of Pain & Palliative Care Pharmacotherapy
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