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Emily Reeve, Wade Thompson, Barbara Farrell
Deprescribing can be defined as the process of withdrawal or dose reduction of medications which are considered inappropriate in an individual. The aim of this narrative review is to provide an overview of "deprescribing"; firstly discussing the potential benefits and harms followed by the barriers to and enablers of deprescribing. We also provide practical recommendations to recognise opportunities and strategies for deprescribing in practice. Studies focused on minimizing polypharmacy indicate that deprescribing may be associated with potential benefits including resolution of adverse drug reactions, improved quality of life and medication adherence and a reduction in drug costs...
January 4, 2017: European Journal of Internal Medicine
Eugene Grudnikoff, Christopher Bellonci
No abstract text is available yet for this article.
January 2017: American Journal of Therapeutics
J Hermanowski, N Levy, P Mills, N Penfold
No abstract text is available yet for this article.
December 29, 2016: Anaesthesia
Jorge Enrique Machado-Alba, Andrés Gaviria-Mendoza, Manuel Enrique Machado-Duque, Laura Chica
It is estimated that one-fifth of adult patients are treated with polypharmacy (five or more drugs) and the prevalence of this phenomenon in the elderly is even higher, ranging from 30% to 70%, even reaching 90% in residents of residential aged care facilities. Polypharmacy in the elderly increases the risk of adverse reactions, inappropriate prescriptions, drug interactions, number of hospitalizations, costs, and even death. In a recent systematic review, the authors proposed defining deprescribing as 'the process of withdrawal of inappropriate medication supervised by a health care professional with the goal of managing polypharmacy and improving outcomes'...
December 26, 2016: Expert Opinion on Drug Safety
Cody D Black, Wade Thompson, Vivian Welch, Lisa McCarthy, Carlos Rojas-Fernandez, Heather Lochnan, Salima Shamji, Ross Upshur, Barbara Farrell
INTRODUCTION: Individualizing glycemic targets to goals of care and time to benefit in persons with type 2 diabetes is good practice, particularly in populations at risk of hypoglycemia and adverse outcomes relating to the use of antihyperglycemics. Guidelines acknowledge the need for relaxed targets in frail older adults, but there is little guidance on how to safely deprescribe (i.e. stop, reduce or substitute) antihyperglycemics. METHODS: The purpose of this study was to synthesize evidence from all studies evaluating the effects of deprescribing versus continuing antihyperglycemics in older adults with type 2 diabetes...
December 15, 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Janet K Sluggett, Jenni Ilomäki, Karla L Seaman, Megan Corlis, J Simon Bell
Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities...
December 10, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Kjell H Halvorsen, Geir Selbaek, Sabine Ruths
PURPOSE: The aim of this study was to examine trends in potentially inappropriate medication (PIM) prescribing in Norwegian nursing homes. METHODS: Patients aged ≥70 years were included from three cross-sectional studies conducted in 1997, 2005 and 2011. PIMs were analyzed according to the Norwegian General Practice-Nursing Home criteria (NORGEP-NH), use of single substances to avoid, combinations to avoid, and deprescribing items. Associations between sample and use of PIMs were examined by logistic regression, adjusted for age, gender, and ward...
December 9, 2016: Pharmacoepidemiology and Drug Safety
Kathleen Abrahamson, Arif Nazir, Karis Pressler
There have been numerous calls within the medical community urging providers to consider the complex problem of inappropriate polypharmacy and inappropriate medication use among nursing home residents. It is clear that innovative, longitudinal policy-supported interventions are needed to better understand prescribing practices in long-term care settings and to curtail the negative, cascading outcomes associated with inappropriate polypharmacy among elderly patients. The Indiana Safer Medication Administration Regimens and Treatment (SMART) campaign is funded by the Indiana State Department of Health for a pilot period of 2 years (2016-18) with the objectives of: 1...
November 30, 2016: Research in Social & Administrative Pharmacy: RSAP
Jennifer Kirsty Harrison, Veronika Van Der Wardt, Simon Paul Conroy, David J Stott, Tom Dening, Adam Lee Gordon, Pip Logan, Tomas James Welsh, Jaspal Taggar, Rowan Harwood, John R F Gladman
The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful. Robust evidence is scant, trials of antihypertensive medications have generally excluded those with dementia. Observational data show changes in risk association over the life course, with high BP being a risk factor for cognitive decline in mid-life, while low BP is predictive in later life...
November 2016: Age and Ageing
Beata Borgström Bolmsjö, Anna Palagyi, Lisa Keay, Jan Potter, Richard I Lindley
BACKGROUND: General Practitioners (GPs) are responsible for primary prescribing decisions in most settings. Elderly patients living in Advanced Care Facilities (ACFs) often have significant co-morbidities to consider when selecting an appropriate drug therapy. Careful assessment is required when considering appropriate medication use in frail older patients as they have multiple diseases and thus multiple medication. Many physicians seem reluctant to discontinue other physicians' prescriptions, resulting in further polypharmacy...
November 5, 2016: BMC Family Practice
Robert H Howland
Polypharmacotherapy is a commonly used, but frequently criticized, clinical practice. Deprescribing is the process of discontinuing inappropriate or unnecessary medications, with the goals of decreasing adverse events and drug-drug interactions, simplifying medication regimens to enhance adherence, and reducing costs associated with medication use while maintaining or improving clinical outcomes. Studies of groups of patients suggest that deprescribing medication is feasible and safe, but individual experiences are masked by group data...
November 1, 2016: Journal of Psychosocial Nursing and Mental Health Services
Jennifer Pruskowski
No abstract text is available yet for this article.
February 2017: Journal of Palliative Medicine
Emily Reeve, Lee-Fay Low, Sepehr Shakib, Sarah N Hilmer
BACKGROUND: Knowledge of consumer (patient and caregiver) attitudes is essential for conducting medication optimization in practice. OBJECTIVES: The aim of this study was to develop and validate a questionnaire to capture older adults' and caregivers' beliefs and attitudes towards deprescribing. METHODS: The previously validated Patients' Attitudes Towards Deprescribing (PATD) questionnaire was expanded based on literature review, expert opinion and focus groups, and a caregivers' version was developed...
December 2016: Drugs & Aging
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
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