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https://www.readbyqxmd.com/read/29138153/deprescribing-antihyperglycemic-agents-in-older-persons-evidence-based-clinical-practice-guideline
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
https://www.readbyqxmd.com/read/28887346/leveraging-electronic-medical-record-data-for-population-health-management-in-the-veterans-health-administration-successes-and-lessons-learned
#15
Jannet M Carmichael, Joy Meier, Amy Robinson, Janice Taylor, Diana T Higgins, Shardool Patel
PURPOSE: The process and operational elements to establish a population health program using electronic medical record data in a Veterans Health Administration region are described. SUMMARY: Pharmacists are uniquely qualified to assume important roles in population health through the use of their clinical knowledge, assisted by electronic tools that consolidate and report patient-specific data for clinical care. Veterans Integrated Services Network (VISN) 21 has developed 300 dashboards and reports to improve the quality, safety, and value of healthcare to veterans...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28870834/prevalence-of-preventive-cardiovascular-medication-use-in-nursing-home-residents-room-for-deprescribing-the-shelter-study
#16
Alireza Malek Makan, Hein van Hout, Graziano Onder, Harriet Finne-Soveri, Henriëtte van der Roest, Rob van Marum
INTRODUCTION: In nursing home (NH) residents with a very short life expectancy, the benefits of preventive cardiovascular medication maintenance are questionable. OBJECTIVE: To assess the prevalence of 4 classes of preventive cardiovascular medication (PCM) in NH residents, and to explore differences of prevalence across length of stay, mortality risk, cognitive impairment, functional disability, and across countries. METHODS: A 12-month prospective cohort study was conducted in 57 NHs in 8 countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands, and Israel)...
September 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28860728/patient-provider-concordance-in-the-perception-of-illness-and-disease-a-cross-sectional-study-among-multimorbid-patients-and-their-general-practitioners-in-switzerland
#17
Stefan Neuner-Jehle, Stefan Zechmann, Daniela Grundmann Maissen, Thomas Rosemann, Oliver Senn
BACKGROUND: Multiple chronic health conditions are leading to multiple treatment procedures and polypharmacy. Prioritizing treatment according to patients' needs and preferences may be helpful for deprescribing. Thus, for improving health care, it is crucial for general practitioners (GPs) to perceive the chief complaints (CCs) of patients. The primary aim of this study was to investigate the patient-provider concordance of CCs and the secondary aim was to investigate the concordance between CCs and diagnosis, in a sample of Swiss multimorbid patients...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28853000/discontinuation-of-preventive-medicines-in-older-people-with-limited-life-expectancy-a-systematic-review
#18
REVIEW
Sujita W Narayan, Prasad S Nishtala
BACKGROUND: In the presence of multimorbidity and limited life expectancy (LLE), the need for continued use of preventive medicines becomes uncertain as they may neither improve health nor confer continued health benefits. OBJECTIVE: Our objective was to systematically review the literature to examine the discontinuation of preventive medicines in older people with LLE. METHODS: A systematic literature search was conducted using the Ovid MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register databases...
October 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28804870/effect-of-the-tool-to-reduce-inappropriate-medications-on-medication-communication-and-deprescribing
#19
RANDOMIZED CONTROLLED TRIAL
Terri R Fried, Kristina M Niehoff, Richard L Street, Peter A Charpentier, Nallakkandi Rajeevan, Perry L Miller, Mary K Goldstein, John R O'Leary, Brenda T Fenton
OBJECTIVES: To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. DESIGN: Randomized clinical trial. SETTING: Primary care clinics at a Veterans Affairs Medical Center. PARTICIPANTS: Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128)...
October 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28764753/supporting-prescribing-in-older-people-with-multimorbidity-and-significant-polypharmacy-in-primary-care-sppire-a-cluster-randomised-controlled-trial-protocol-and-pilot
#20
Caroline McCarthy, Barbara Clyne, Derek Corrigan, Fiona Boland, Emma Wallace, Frank Moriarty, Tom Fahey, Carmel Hughes, Paddy Gillespie, Susan M Smith
BACKGROUND: Multimorbidity, defined as the presence of at least two chronic conditions, becomes increasingly common in older people and is associated with poorer health outcomes and significant polypharmacy. The National Institute for Clinical Excellence (NICE) recently published a multimorbidity guideline that advises providing an individualised medication review for all people prescribed 15 or more repeat medicines. This study incorporates this guideline and aims to assess the effectiveness of a complex intervention designed to support general practitioners (GPs) to reduce potentially inappropriate prescribing and consider deprescribing in older people with multimorbidity and significant polypharmacy in Irish primary care...
August 1, 2017: Implementation Science: IS
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