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Weir KR, Vordenberg SE, Scherer AM, Jansen J, Schoenborn N, Todd A. Exploring Different Contexts of Statin Deprescribing: A Vignette-Based Experiment with Older Adults Across Four Countries. J Gen Intern Med 2024:10.1007/s11606-024-08698-7. [PMID: 38514582 DOI: 10.1007/s11606-024-08698-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Kristie Rebecca Weir
- Sydney School of Public Health, Menzies Centre for Health Policy & Economics, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
| | - Sarah E Vordenberg
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Aaron M Scherer
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jesse Jansen
- Department of Family Medicine, Care and Public Health Research Institute (CAHRI), Faculty of Health Medicine and Life Sciences (FHML) Maastricht University, Maastricht, the Netherlands
| | | | - Adam Todd
- Newcastle University School of Pharmacy, Newcastle upon Tyne, UK
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Brunner L, Mooser B, Spinewine A, Rodondi N, Aubert CE. Older Adult Perspectives on Statin Continuation and Discontinuation in Primary Cardiovascular Disease Prevention: A Mixed-Methods Study. Patient Prefer Adherence 2024; 18:15-27. [PMID: 38196947 PMCID: PMC10773265 DOI: 10.2147/ppa.s432448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Background and Purpose Evidence for statin use for primary cardiovascular disease prevention in older adults is limited. When evidence on risk-benefit profile of a medication is uncertain, using it or not becomes a preference-sensitive decision. We aimed to assess and explore patient perspectives on continuation and discontinuation of statins used for primary cardiovascular prevention in older adults. Patients and Methods We used a convergent mixed-methods design, conducting in parallel a survey among 47 patients and three focus groups (FGs) with 14 patients total. We recruited patients aged ≥65 years and taking a statin for primary cardiovascular prevention. The survey and FGs aimed to assess and explore patient experiences of statin use, and views on statin continuation and discontinuation, including patient decision-making. Quantitative and qualitative data were first analyzed separately - descriptive statistics for quantitative data and thematic analysis for qualitative data - and then integrated to create metainferences, using joint displays. Results Forty-one percent of patients (N=19) were reluctant to discontinue the statin, whereas 22% (N=10) were willing to try discontinuing it. A reason to continue the statin was its perceived necessity, while self-estimated low cardiovascular risk and wish to reduce medication burden were given as reasons to discontinue it. Lack of expertise assumed by the patients to decide about statin continuation or discontinuation, uncertainty about statin indication, and fear of having a cardiovascular event after discontinuation made many patients uncertain about deciding to continue or discontinue the statin. In this context, 70% (N=33) would rather have their physician choose for them, and 94% (N=44) would continue taking the statin for as long as their physician told them to do so. Conclusion This study highlights factors that influence patient willingness to continue or discontinue statins, patient uncertainty about statin continuation or discontinuation, and the important role physicians play in the decision-making process.
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Affiliation(s)
- Laureline Brunner
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Blandine Mooser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Spinewine
- Université catholique de Louvain, Louvain Drug Research Institute, Clinical Pharmacy Research Group, Brussels, Belgium; Department of Pharmacy, Centre Hospitalier Universitaire (CHU) UCL Namur, Yvoir, Belgium
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carole Elodie Aubert
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bolt J, Abdoulrezzak R, Inglis C. Barriers and enablers to deprescribing of older adults and their caregivers: a systematic review and meta-synthesis. Eur Geriatr Med 2023; 14:1211-1222. [PMID: 37874489 DOI: 10.1007/s41999-023-00879-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The primary objective of this study was to identify the barriers and enablers to deprescribing from the viewpoint of community-dwelling older adults and their caregivers. METHODS This meta-synthesis included a systematic review of the literature and an inductive thematic synthesis. Medline and EMBASE were searched for studies that qualitatively explored the perspectives of older adults or their caregivers on deprescribing. Studies had to use qualitative methodologies and include community-dwelling adults (or their caregivers) aged 60 years or older who were taking one or more chronic medications. The quality of studies was assessed using the CASP tool. RESULTS Fourteen studies were included in the meta-synthesis. All studies included older adults, and 3 included caregivers or companions. Four barriers were identified: favorable perceptions of medications, fear of medication discontinuation, the complexity of the healthcare system and discouragement from healthcare professionals; and seven enablers were identified: medication safety concerns, patient autonomy and confidence, education, follow-up, deprescribing strategies, relationships with physicians, and patient-perceived benefits of deprescribing. CONCLUSION Multiple barriers and enablers to deprescribing exist within the older adult population. Health system complexity and direct discouragement from healthcare providers were barriers uniquely identified in the older adult population. This population would benefit from interventions to increase their medication literacy, confidence, and autonomy in the deprescribing journey.
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Affiliation(s)
- Jennifer Bolt
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
- Interior Health Authority, Pharmacy Services, 505 Doyle Ave, Kelowna, BC, V1Y 6V8, Canada.
| | - Reema Abdoulrezzak
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Inglis
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Island Health Authority, Pharmacy Services, Courtenay, BC, Canada
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Chan M, Plakogiannis R, Stefanidis A, Chen M, Saraon T. Pharmacist-Led Deprescribing for Patients With Polypharmacy and Chronic Disease States: A Retrospective Cohort Study. J Pharm Pract 2023; 36:1192-1200. [PMID: 35522029 DOI: 10.1177/08971900221097246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Current literature and practice have demonstrated that pharmacists have an integral role in deprescribing. However, research regarding their impact on patients with chronic diseases is limited. Objective: To assess the impact of a pharmacist-led intervention on deprescribing inappropriate medication for patients with chronic diseases within a four-month study period compared to patients receiving usual care. Methods: This study was conducted at NYU Langone Health. Patients of the intervention group were referred by a provider and met the criteria of polypharmacy, required chronic disease states management, were nonadherent to medications, had poor health literacy, or required titration for heart failure (HF) guideline directed medical therapy. Results: A total of 142 patients were reviewed over a two-year period. At the end of the study period, the median number of medications for the two respective groups was similar (11 [4 - 30] vs 11 [2 - 23]). The pharmacist-led intervention had on average one medication deprescribed (m = -1.00, sd = 2.57), whereas the control group had on average .44 additional medications (m = 0.44, sd = 3.32) prescribed. Furthermore, the intervention group presented statistically significant differences (P = 0.046) regarding their diastolic blood pressure after the pharmacists' intervention (m = 72.69, sd = 11.64). Most importantly, patients with HF presented statistically significant improvement in their ejection fractions after the intervention (m = 41.46%, sd = 19.28%). Conclusion: The pharmacist-led intervention resulted in significant discontinuation of medications for patients in the intervention group compared to those in the usual care group within four-months.
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Affiliation(s)
- Mabel Chan
- Ambulatory Care Clinical Pharmacist, NYC Health+Hospitals, Brooklyn, NY, USA
- Arnold and Marie Schwartz College of Pharmacy & Health Sciences Long Island University, Brooklyn, NY, USA
| | - Roda Plakogiannis
- Arnold and Marie Schwartz College of Pharmacy & Health Sciences Long Island University, Brooklyn, NY, USA
- PGY-2 Ambulatory Care Residency Program Director, NYU Langone Health, New York, NY, USA
| | - Abraham Stefanidis
- Department of Management, The Peter J. Tobin College of Business, St. John's University, New York, NY, USA
| | - Mandy Chen
- Arnold and Marie Schwartz College of Pharmacy & Health Sciences Long Island University, Brooklyn, NY, USA
- Shields Health Solutions, Stoughton, Massachusetts, UK
| | - Tajinderpal Saraon
- Physician, Department of Medicine, NYU Grossman School of Medicine, NY, USA
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S. B, Yadav SK, Sharma D, Agarwal P, Jha S, Shekhar S, Sharma DB, Mishra A. Patient Perspectives After Surgery-Related Complications Among Breast Cancer Patients from a LMIC. Indian J Surg Oncol 2023; 14:595-600. [PMID: 37900625 PMCID: PMC10611678 DOI: 10.1007/s13193-023-01721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
Long-term quality of life in breast cancer patients has been studied and published regularly. However, the lived experiences of patients who develop complications after surgery are not well understood. Determining this experience of patients is challenging in most low- and middle-income countries where the majority of patients belong to poor strata of society and are uneducated. We aimed to explore the thoughts, feelings, and experiences of patients with surgery-related complications after breast cancer surgery. Purposive sampling was used to identify patients who developed any postoperative complication, and semi-structured interviews were conducted. Common patterns of patient experiences were identified and analyzed using descriptive thematic analysis. Twenty-eight patients out of 210 developing complications postoperatively were identified. The median age was 48 years (range 32-65 years). The majority (n = 26) were housewives, educated below the primary level (n = 11) and below the poverty line (n = 13). Complications included seroma (n = 17), flap necrosis and infection (n = 5), and hematoma (n = 1). Seven domains emerged from the interviews-knowledge of complications, psychological impact, burden, disruptiveness, social impact, relationship with the surgical team, and suggestions to improve the experience. The themes identified in the present study provide insights into the lived experiences and can inform the future development of patient-reported outcome measures and quality improvement programs, including more effective pre-operative counseling and consent. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-023-01721-z.
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Affiliation(s)
- Bharath S.
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | | | | | - Pawan Agarwal
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | - Shikha Jha
- Department of Psychiatry, AIIMS, Patna, India
| | - Saket Shekhar
- Department of Preventive, Social Medicine and Biostatistics, Rama Medical College, Kanpur, India
| | | | - Arpan Mishra
- Department of Surgery, NSCB Medical College, Jabalpur, India
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Zreik J, Kato M, Bailey B, Biggs WS, Hamadeh G. Polypharmacy Prevalence and Perceptions of Deprescribing in Elderly Patients Among Community Primary Care Providers in Mid-Michigan Practices. Cureus 2023; 15:e39399. [PMID: 37378090 PMCID: PMC10292136 DOI: 10.7759/cureus.39399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Polypharmacy is common among the elderly and can predispose them to increased morbidity and higher healthcare expenditures. Deprescribing is an important aspect of preventative medicine to minimize polypharmacy-related adverse effects. Mid-Michigan has historically been considered a medically underserved area. We sought to describe polypharmacy prevalence and primary care provider (PCP) perceptions of deprescribing in the elderly at community practices in the region. METHODS Medicare Part D claims data from 2018 to 2020 were queried to calculate the prevalence of polypharmacy, which is defined as Medicare beneficiaries who were concurrently prescribed at least five medications. PCPs from four community practices in adjacent counties in mid-Michigan, including two high- and two low-prescribing practices, were surveyed to assess their perceptions of deprescribing. RESULTS The prevalence of polypharmacy in two adjacent mid-Michigan counties was 44.0% and 42.5%, which was similar to Michigan's overall prevalence of 40.7% (p = 0.720 and 0.844, respectively). Additionally, 27 survey responses were received from mid-Michigan PCPs (response rate, 30.7%). Most respondents expressed confidence in deprescribing in the elderly from a clinical standpoint (66.7%). Barriers to deprescribing included patient/family concerns (70.4%) and lack of time during office visits (37.0%). Facilitators to deprescribing included patient readiness (18.5%), collaboration with case managers/pharmacists (18.5%), and up-to-date medication lists (18.5%). An exploratory comparison of perceptions at high- and low-prescribing practices showed no significant differences. CONCLUSION These findings demonstrate a high prevalence of polypharmacy in mid-Michigan and suggest that PCPs in the region are generally supportive of deprescribing. Potential targets to improve deprescribing in patients with polypharmacy include addressing visit length, patient/family concerns, increasing interdisciplinary collaboration, and medication reconciliation support.
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Affiliation(s)
- Jad Zreik
- Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA
| | - Mark Kato
- Public Health, Michigan Health Improvement Alliance, Midland, USA
| | - Beth Bailey
- Health Services Research, Central Michigan University College of Medicine, Saginaw, USA
| | - Wendy S Biggs
- Family Medicine, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Ghassan Hamadeh
- Family Medicine, Central Michigan University College of Medicine, Saginaw, USA
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Badou JP. Les patients face à la déprescription. ACTUALITES PHARMACEUTIQUES 2023. [DOI: 10.1016/j.actpha.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Cho TH, Ng PCK, Lefebvre MJ, Desjarlais A, McCann D, Waldvogel B, Tonelli M, Garg AX, Wilson J, Beaulieu M, Marin J, Orsulak C, Talson M, Sharma M, Feldberg J, Bohm C, Battistella M. Development and Validation of Patient Education Tools for Deprescribing in Patients on Hemodialysis. Can J Kidney Health Dis 2023; 10:20543581221150676. [PMID: 36711225 PMCID: PMC9880575 DOI: 10.1177/20543581221150676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2023] Open
Abstract
Background Deprescribing is a patient-centered solution to reducing polypharmacy in patients on hemodialysis (HD). In a deprescribing pilot study, patients were hesitant to participate due to limited understanding of their own medications and their unfamiliarity with the concept of deprescribing. Therefore, patient education materials designed to address these knowledge gaps can overcome barriers to shared decision-making and reduce hesitancy regarding deprescribing. Objective To develop and validate a medication-specific, patient education toolkit (bulletin and video) that will supplement an upcoming nationwide deprescribing program for patients on HD. Methods Patient education tools were developed based on the content of previously validated deprescribing algorithms and literature searches for patients' preferences in education. A preliminary round of validation was completed by 5 clinicians to provide feedback on the accuracy and clarity of the education tools. Then, 3 validation rounds were completed by patients on HD across 3 sites in Vancouver, Winnipeg, and Toronto. Content and face validity were evaluated on a 4-point and 5-point Likert scale, respectively. The content validity index (CVI) score was calculated after each round, and revisions were made based on patient feedback. Results A total of 105 patients participated in the validation. All 10 education tools achieved content and face validity after 3 rounds. The CVI score was 1.0 for most of the tools, with 0.95 being the lowest value. Face validity ranged from 72% to 100%, with majority scoring above 90%. Conclusion Ten patient education tools on deprescribing were developed and validated by patients on HD. These validated, medication-specific education tools are the first of its kind for patients on HD and will be used in a nationwide implementation study alongside the validated deprescribing algorithms developed by our research group.
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Affiliation(s)
| | - Patrick C. K. Ng
- Department of Pharmacy, University
Health Network, Toronto, ON, Canada
| | | | | | - Dennis McCann
- Patient Partners, Can-SOLVE CKD
Network, Vancouver, BC, Canada
| | - Blair Waldvogel
- Patient Partners, Can-SOLVE CKD
Network, Vancouver, BC, Canada
| | | | - Amit X. Garg
- Institute for Clinical Evaluative
Sciences, Toronto, ON, Canada,Division of Nephrology, Department of
Medicine, Epidemiology and Biostatistics, Western University, London, ON,
Canada
| | - JoAnne Wilson
- Division of Nephrology, Department of
Medicine, Nova Scotia Health Authority, Halifax, Canada,Faculty of Health, Dalhousie
University, Halifax, NS, Canada
| | - Monica Beaulieu
- Division of Nephrology, The University
of British Columbia, Vancouver, Canada
| | | | | | - Melanie Talson
- Department of Internal Medicine, Max
Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Monica Sharma
- Department of Internal Medicine, Max
Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jordanne Feldberg
- Department of Pharmacy, University
Health Network, Toronto, ON, Canada
| | - Clara Bohm
- Department of Internal Medicine, Max
Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Marisa Battistella
- Department of Pharmacy, University
Health Network, Toronto, ON, Canada,Leslie Dan Faculty of Pharmacy,
University of Toronto, ON, Canada,Marisa Battistella, Department of Pharmacy,
University Health Network, 200 Elizabeth Street, EB 214, Toronto, ON M5G 2C4,
Canada.
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Abstract
OBJECTIVE To synthesise the current knowledge on barriers and facilitators to deprescribing cardiovascular medications (CVMs) at the levels of patients, informal caregivers and healthcare providers (HCPs). DESIGN/SETTING We conducted a systematic review of studies exploring/assessing patient, informal caregiver and/or HCP barriers and/or facilitators to deprescribing CVMs. DATA SOURCES Ovid/MEDLINE and Embase from January 2003 to November 2021. DATA EXTRACTION AND SYNTHESIS We performed a deductive thematic analysis based on the framework of specific barriers and facilitators to deprescribing CVMs created by Goyal et al. We added a quantification of the occurrence of categories and themes in the selected articles to identify the resounding themes that indicate the greater impetus to address in future research. RESULTS Most frequent deprescribing barriers for patients, informal caregivers and HCPs included uncertainty due to lack of evidence regarding CVM deprescribing (in n=10 studies), fear of negative consequences following deprescribing (n=13) and social influences (n=14). A frequently reported facilitator to deprescribing, especially for patients and informal caregivers, was the occurrence of adverse drug events (n=7). Another frequently reported facilitator for patients were dislike of CVMs (n=9). Necessity and benefit of CVMs were seen as barriers or facilitators similarly by patients and HCPs. CONCLUSION The differences in patient, informal caregiver and HCP regarding barriers and facilitators to deprescribing CVMs stress the need for ground discussions about beliefs and preferences of each stakeholder implicated in deprescribing decisions. Furthermore, HCP uncertainty regarding CVM deprescribing highlights the need to provide HCPs with tools that enable sharing the risks and benefits of deprescribing with patients and ensure a safe deprescribing process. PROSPERO REGISTRATION NUMBER CRD42020221973.
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Affiliation(s)
- Laureline Brunner
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carole Elodie Aubert
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Pereira A, Ribeiro O, Veríssimo M. Translation, cross-cultural adaptation and validation of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to Portuguese: Older adults version. Res Social Adm Pharm 2022; 19:123-132. [PMID: 36115808 DOI: 10.1016/j.sapharm.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deprescribing is a patient-centered approach to managing inappropriate polypharmacy that faces several barriers, including patients' attitudes and beliefs about medications that need to be considered. For this purpose, the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire is a helpful instrument, but until now, there is no Portuguese version. OBJECTIVES To translate and validate the rPATD questionnaire (older adults version) to Portuguese. METHODS The rPATD questionnaire was translated and cross-culturally adapted using forward-backward translation and pre-testing. A cross-sectional study with 192 older adults aged ≥65 years taking at least 1 regular medication was conducted for validity assessment. Participants were recruited by convenience sampling in 3 Portuguese outpatient rehabilitation medicine clinics. Psychometric properties were evaluated through face and content validity; construct validity, by assessing structural validity through exploratory factor analysis, hypotheses testing, including concurrent validity and cross cultural validity; reliability with internal consistency; and item-total correlation. Floor and ceiling effects were examined. RESULTS The exploratory factor analysis (EFA) revealed a 4-factor structure that explains 51.08% of the total variance, as in the original rPATD. These 4 factors are related to the level of involvement in medication management, beliefs in the appropriateness of medication, perceived burden of medication, and concerns about stopping medications. Factor loadings ranged from 0.226 to 0.800; 2 items scored <0.3, and no cross-loading was found. The exclusion of the 2 items loading <0.3 in the EFA showed no significant improvement in factor loading or internal consistency, so the item structure was maintained. In hypothesis testing, 78% of the correlations were correctly predicted. The 4 factors internal consistency was generally acceptable, with Cronbach's alpha ranging from 0.638 to 0.830. The item-total correlation ranged between 0.223 and 0.7. CONCLUSION The Portuguese rPATD questionnaire for older adults presents globally good or acceptable psychometric properties.
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Affiliation(s)
- Anabela Pereira
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal; Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Manuel Veríssimo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
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Seewoodharry M, Khunti K, Davies MJ, Gillies C, Seidu S. Attitudes of older adults and their carers towards de-prescribing: A systematic review. Diabet Med 2022; 39:e14801. [PMID: 35118700 DOI: 10.1111/dme.14801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Abstract
AIM The aim of this systematic review is to explore the attitudes of older adults (≥65 years old) and their carers towards de-prescribing. METHODS We identified relevant studies from three databases; MEDLINE, CINAHL and Web of Science. Two reviewers (MS, SS) independently extracted data from each selected study using a standardised self-developed data extraction form. Main findings of the studies were summarised descriptively. RESULTS A total of 35 studies were included in the review. Of them, 19 were questionnaire studies, 11 semi-structured interviews, 4 focus groups and 1 study used the nominal group technique approach. Most older adults and their carers were willing to have medication de-prescribed if told to do so by a healthcare professional (HCP). Other factors that increased willingness to de-prescribing included; trust in the HCP, side effects and inconvenience from medications as well as the prospect of follow-up and monitoring during de-prescribing. In contrast, perceived effectiveness, unawareness of lack of benefit, negative expectations of ageing and fear were factors preventing de-prescribing. CONCLUSION De-prescribing is an important concept in older people given the harm associated with polypharmacy in this age group. Overall, older adults and their carers are willing to have medication de-prescribed if facilitated by their HCP. However, there remain a few barriers to de-prescribing which may need to be addressed in certain patients, through discussions between older adults/their carers and a HCP, to allow de-prescribing to be more effective.
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Affiliation(s)
- Mansha Seewoodharry
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
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Development and consensus testing of quality indicators for geriatric pharmacotherapy in primary care using a modified Delphi study. Int J Clin Pharm 2022; 44:517-538. [PMID: 35380394 PMCID: PMC9007756 DOI: 10.1007/s11096-022-01375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/03/2022] [Indexed: 11/05/2022]
Abstract
Background Polypharmacy is associated with an increased risk of adverse drug events in older people. Although national guidance on geriatric pharmacotherapy exists in Japan, tools to routinely monitor the quality of care provided by community pharmacists are lacking. Aim To develop a set of quality indicators (QIs) to measure the quality of care provided by community pharmacists in improving geriatric pharmacotherapy in primary care in Japan, using a modified Delphi study. Method The development of QIs for the Japanese community pharmacy context followed a two-step process: national guidance review and consensus testing using a modified Delphi study. The latter involved two rounds of rating with a face-to-face meeting between the rounds. Ten experts in geriatric pharmacotherapy in primary care were recruited for the panel discussion. QIs were mapped to three key taxonomies and frameworks: the Anatomical Therapeutic Chemical (ATC) classification system, problems and causes of drug-related problems (DRPs) taxonomy and Donabedian's framework. Results A total of 134 QIs for geriatric pharmacotherapy were developed. This QI set included 111 medicine specific indicators, covering medicines in 243 third-level ATC classifications. QIs were classified into the problem of treatment safety (80%) and causes of drug selection (38%) based on validated classification for DRPs. In Donabedian's framework, most QIs (82%) were process indicators. There were no structure indicators. Conclusion A set of 134 QIs for geriatric pharmacotherapy was rigorously developed. Measurement properties of these QIs will be evaluated for feasibility, applicability, room for improvement, sensitivity to change, predictive validity, acceptability and implementation issues in a subsequent study.
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Stefil M, Dixon M, Bahar J, Saied S, Mashida K, Heron O, Shantsila E, Walker L, Akpan A, Lip GY, Sankaranarayanan R. Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist. Card Fail Rev 2022; 8:e34. [PMID: 36891063 PMCID: PMC9987511 DOI: 10.15420/cfr.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/30/2022] [Indexed: 12/23/2022] Open
Abstract
Heart failure (HF) is a common health condition that typically affects older adults. Many people with HF are cared for on an inpatient basis, by noncardiologists, such as acute medical physicians, geriatricians and other physicians. Treatment options for HF are ever increasing, and adherence to guidelines for prognostic therapy contributes to polypharmacy, which is very familiar to clinicians who care for older people. This article explores the recent trials in both HF with reduced ejection fraction and HF with preserved ejection fraction and the limitations of international guidance in their management with respect to older people. In addition, this article discusses the challenge of managing polypharmacy in those with advanced age, and the importance of involving a geriatrician and pharmacist in the HF multidisciplinary team to provide a holistic and person-centred approach to optimisation of HF therapies.
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Affiliation(s)
- Maria Stefil
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust Liverpool, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool, UK
| | - Matthew Dixon
- Department of Medicine for the Elderly, Wirral University Teaching Hospital NHS Foundation Trust Wirral, UK
| | - Jameela Bahar
- School of Medicine, University of Liverpool Liverpool, UK
| | - Schabnam Saied
- School of Medicine, University of Liverpool Liverpool, UK
| | | | - Olivia Heron
- School of Medicine, University of Liverpool Liverpool, UK
| | - Eduard Shantsila
- Department of Primary Care and Mental Health, University of Liverpool Liverpool, UK
| | - Lauren Walker
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool Liverpool, UK
| | - Asangaedem Akpan
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust Liverpool, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool, UK.,Department of Clinical Medicine, Aalborg University Aalborg, Denmark
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science, University of Liverpool Liverpool, UK.,Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust Liverpool, UK
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14
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Hooper MA, Renshaw SM, Poulose BK. Patient perspectives on mesh-related complications after hernia repair. Surgery 2021; 171:994-999. [PMID: 34774293 DOI: 10.1016/j.surg.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND To explore the thoughts, feelings, and experiences of patients with mesh-related complications after hernia repair. The rate of long-term mesh-related complications requiring procedural intervention after abdominal core surgery, including hernia repair, is unknown. Determining this rate is challenging due to its anticipated low chance of occuring and historically poor systematic long-term follow-up in patients' hernia repair. The lived experience of these patients is also not well understood. METHODS Purposive sampling was used to identify patients who have experienced mesh-related complications after hernia repair, and semistructured interviews were conducted. Descriptive thematic analysis was used to identify, analyze, and report common patterns across the data set related to the patient experience of mesh-related complications. RESULTS Eight patients who had undergone a hernia repair with mesh and had at least 1 mesh-related complication after their repair requiring operation, an additional procedure, or medical treatment were included in the study and completed semistructured interviews over the phone. Five domains emerged from the interviews: indicators of mesh-related complications, knowledge of potential surgical complications, relationship/satisfcation with surgeon and/or surgical team, psychosocial impact of hernia repair and mesh-related complications, and function. CONCLUSION Despite the widespread use of mesh in abdominal wall operations, little is known regarding the patient experience of mesh-related complications. The themes identified in the present study provide insight into the patient experience of mesh-related complications and can inform the future development of a patient-reported outcome measure to determine the true incidence of mesh-related complications and the impact of these complications on quality of life.
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Affiliation(s)
| | - Savannah M Renshaw
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin K Poulose
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
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15
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Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Reviewing Potentially Inappropriate Medication in Hospitalized Patients Over 65 Using Explicit Criteria: A Systematic Literature Review. Drug Healthc Patient Saf 2021; 13:183-210. [PMID: 34764701 PMCID: PMC8572741 DOI: 10.2147/dhps.s303101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
Potentially inappropriate medication (PIM) is a primary health concern affecting the quality of life of patients over 65. PIM is associated with adverse drug reactions including falls, increased healthcare costs, health services utilization and hospital admissions. Various strategies, clinical guidelines and tools (explicit and implicit) have been developed to tackle this health concern. Despite these efforts, evidence still indicates a high prevalence of PIM in the older adult population. This systematic review explored the practice of using explicit tools to review PIM in hospitalized patients and examined the outcomes of PIM reduction. A literature search was conducted in several databases from their inception to 2019. Original studies that had an interventional element using explicit criteria detecting PIM in hospitalized patients over 65 were included. Descriptive narrative synthesis was used to analyze the included studies. The literature search yielded 6116 articles; 25 quantitative studies were included in this systematic literature review. Twenty were prospective studies and five were retrospective. Approximately, 15,500 patients were included in the review. Various healthcare professionals were involved in reviewing PIM including physicians and hospital pharmacists. Several tools were used to review PIM for hospitalized patients over 65, most frequently Beer’s criteria and the STOPP/START tool. The reduction of PIM ranged from 3.5% up to 87%. The most common PIM were benzodiazepines and antipsychotics. This systematic review showed promising outcomes in terms of improving patient outcomes. However, the reduction of PIM varied in the studies, raising the question of the variance between hospitals in the explicit tools used for review. Additional studies need to be conducted to further investigate the outcomes of reviewing PIM at different levels, as well as assessing the cost-effectiveness of using explicit tools in reducing PIM.
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Affiliation(s)
- Hesah Alshammari
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Correspondence: Hesah Alshammari Email
| | - Eman Al-Saeed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zamzam Ahmed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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16
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Lundby C, Simonsen T, Ryg J, Søndergaard J, Pottegård A, Lauridsen HH. Translation, cross-cultural adaptation, and validation of the Danish version of the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire: Version for older people with limited life expectancy. Res Social Adm Pharm 2021; 17:1444-1452. [DOI: 10.1016/j.sapharm.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 01/08/2023]
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17
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Crutzen S, Abou J, Smits SE, Baas G, Hugtenburg JG, Heringa M, Denig P, Taxis K. Older people's attitudes towards deprescribing cardiometabolic medication. BMC Geriatr 2021; 21:366. [PMID: 34134649 PMCID: PMC8207766 DOI: 10.1186/s12877-021-02249-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overtreatment with cardiometabolic medication in older patients can lead to major adverse events. Timely deprescribing of these medications is therefore essential. Self-reported willingness to stop medication is usually high among older people, still overtreatment with cardiometabolic medication is common and deprescribing is rarely initiated. An important barrier for deprescribing reported by general practitioners is the patients' unwillingness to stop the medication. More insights are needed into the influence of patients' characteristics on their attitudes towards deprescribing and differences in these attitudes between cardiometabolic medication groups. METHODS A survey in older people using cardiometabolic medication using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was performed. Participants completed the general rPATD and an adapted version for four medication groups. Linear and ordinal logistic regression were used to assess the influence of age, sex, therapeutic area and number of medications used on the patients' general attitudes towards deprescribing. Univariate analysis was used to compare differences in deprescribing attitudes towards sulfonylureas, insulins, antihypertensive medication and statins. RESULTS Overall, 314 out of 1143 invited participants completed the survey (median age 76 years, 54% female). Most participants (80%) were satisfied with their medication and willing to stop medications if their doctor said it was possible (88%). Age, sex and therapeutic area had no influence on the general attitudes towards deprescribing. Taking more than ten medicines was significantly associated with a higher perceived medication burden. Antihypertensive medication and insulin were considered more appropriate than statins, and insulin was considered more appropriate than sulfonylureas not favouring deprescribing. CONCLUSIONS The majority of older people using cardiometabolic medication are willing to stop one of their medicines if their doctor said it was possible. Health care providers should take into account that patients perceive some of their medication as more appropriate than other medication when discussing deprescribing.
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Affiliation(s)
- Stijn Crutzen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
- Universitair Medisch Centrum Groningen, Petra Denig Clinical Pharmacy and Pharmacology, EB70, Postbus 30.001, Hanzeplein1, 9700 RB, Groningen, The Netherlands.
| | - Jamila Abou
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Sanne E Smits
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gert Baas
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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18
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Navid P, Nguyen L, Jaber D, Zarzuela K, Musse M, Lu Wang M, Requijo T, Kozlov E, Masterson Creber RM, Hilmer SN, Lachs M, Goyal P. Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction. J Am Geriatr Soc 2021; 69:1948-1955. [PMID: 33978239 PMCID: PMC9198814 DOI: 10.1111/jgs.17204] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Attitudes toward deprescribing could vary among subpopulations. We sought to understand patient attitudes toward deprescribing among patients with heart failure with preserved ejection fraction (HFpEF). DESIGN Retrospective cohort study. SETTING Academic medical center in New York City. PARTICIPANTS Consecutive patients with HFpEF seen in July 2018-December 2019 at a program dedicated to providing care to older adults with HFpEF. MEASUREMENTS We assessed the prevalence of vulnerabilities outlined in the domain management approach for caring for patients with heart failure and examined data on patient attitudes toward having their medicines deprescribed via the revised Patient Attitudes Toward Deprescribing (rPATD). RESULTS Among 134 patients with HFpEF, median age was 75 (interquartile range 69-82), 60.4% were women, and 35.8% were nonwhite. Almost all patients had polypharmacy (94.0%) and 56.0% had hyperpolypharmacy; multimorbidity (80.6%) and frailty (78.7%) were also common. Overall, 90.3% reported that they would be willing to have one or more of their medicines deprescribed if told it was possible by their doctors; and 26.9% reported that they would like to try stopping one of their medicines to see how they feel without it. Notably, 91.8% of patients reported that they would like to be involved in decisions about their medicines. In bivariate logistic regression, nonwhite participants were less likely to want to try stopping one of their medicines to see how they feel without it (odds ratio 0.25, 95% confidence interval [0.09-0.62], p = 0.005). CONCLUSIONS Patients with HFpEF contend with many vulnerabilities that could prompt consideration for deprescribing. Most patients with HFpEF were amenable to deprescribing. Race may be an important factor that impacts patient attitudes toward deprescribing.
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Affiliation(s)
- Pedram Navid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Linh Nguyen
- School of Medicine, University of Colorado, Boulder, Colorado, USA
| | - Diana Jaber
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Kate Zarzuela
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mahad Musse
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Marcos Lu Wang
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Tatiana Requijo
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Elissa Kozlov
- Institute for Health, Health Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | | | - Sarah N Hilmer
- Kolling Institute, University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mark Lachs
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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19
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Unlu O, Levitan EB, Maurer MS, Safford MM, Lachs MS, Goyal P. Response by Unlu et al to Letter Regarding Article, "Polypharmacy in Older Adults Hospitalized for Heart Failure". Circ Heart Fail 2021; 14:e008305. [PMID: 33706544 DOI: 10.1161/circheartfailure.121.008305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ozan Unlu
- Department of Medicine (O.U.), Weill Cornell Medicine, New York, NY
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham (E.B.L.)
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, NY (M.S.M.)
| | - Monika M Safford
- Division of General Internal Medicine/Department of Medicine (M.M.S., P.G.), Weill Cornell Medicine, New York, NY
| | - Mark S Lachs
- Division of Geriatrics/Department of Medicine (M.S.L.), Weill Cornell Medicine, New York, NY
| | - Parag Goyal
- Division of General Internal Medicine/Department of Medicine (M.M.S., P.G.), Weill Cornell Medicine, New York, NY.,Division of Cardiology/Department of Medicine (P.G.), Weill Cornell Medicine, New York, NY
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20
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Lundby C, Glans P, Simonsen T, Søndergaard J, Ryg J, Lauridsen HH, Pottegård A. Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents. J Am Geriatr Soc 2021; 69:1508-1518. [PMID: 33598916 DOI: 10.1111/jgs.17054] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents. DESIGN Interview-based questionnaire study. SETTING Denmark. PARTICIPANTS Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation-Memory-Concentration score of ≥8. MEASUREMENTS Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics. RESULTS Participants had a median age of 82 years (interquartile range [IQR] 76-89) and used a median of 8 medications (IQR 5-10). Thirty-three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden" score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median "involvement" score 80 vs 75, p < 0.05) and geriatric inpatients (median "involvement" score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased "burden" score (ptrend = 0.001): Those using 1-4 medications daily had a median score of 25 (IQR 17-33) compared to 58 (IQR 42-75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping" score (ptrend = 0.001) and a lower "appropriateness" score (ptrend < 0.001), respectively. CONCLUSION Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.
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Affiliation(s)
- Carina Lundby
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense C, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark
| | - Peter Glans
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
| | - Trine Simonsen
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark
| | - Jesper Ryg
- ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark.,Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Henrik Hein Lauridsen
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Anton Pottegård
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark
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21
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Rodrigues LS, Tinoco MS, Silva LGRD, Cardoso CS, Sousa LCCD, Gonçalves AMRF, Baldoni AO. Barriers and enablers to deprescribing benzodiazepines in older adults: elaborating an instrument and validating its content. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: To elaborate and validate an instrument on barriers and enablers to deprescribing benzodiazepines in the patient’s perspective. METHODS: This study was conducted in 3 stages: (1) a methodological stage, (2) a semi-structured pilot interview with 25 older adults undergoing clonazepam deprescribing, and (3) content validation with the Delphi technique. Content validation was performed by 50 specialists with degrees and/or experience with primary health care and/or health care of older adults, such as physicians, pharmacists, and nurses. For evaluating the obtained results, we analyzed the concordance of evaluations with the coefficient of content validity (CCV). We considered values equal to or higher than 0.8 as acceptable levels of concordance. RESULTS: The instrument was considered validated in the first round of evaluation, where all items obtained a CCV of more than 0.8 in the specialists’ assessment. Nevertheless, they proposed improvements that were incorporated to the final version of the questionnaire. CONCLUSION: The instrument represents an important tool to be used by health care professionals for optimizing benzodiazepine deprescribing, with suitable levels of clarity and validity.
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