Medication use in people with cystic fibrosis before and after modulator therapy

Barriers and enablers to deprescribing for people living with cystic fibrosis: Multidisciplinary perspectives

BACKGROUND

Cystic fibrosis (CF) is a complex genetic disorder necessitating extensive treatment regimens leading to significant medication burden. The recent use of modulator therapies have questioned the necessity of traditional CF treatments, prompting re-evaluation of strategies to reduce treatment burden. This study aimed to identify the barriers and enablers to deprescribing from the perspectives of doctors, nurses, and pharmacists caring for people with CF (PwCF).

METHODS

A qualitative study design employing semi-structured interviews was utilised. Healthcare practitioners (HCPs) across Australia were recruited and interviewed. Interviews were transcribed and analysed using NVivo 1.3 software, guided by an existing framework focusing on self-efficacy, feasibility, inertia, and awareness.

RESULTS

Eleven HCP participated (doctors, n = 3, nurses, n = 4, pharmacists, n = 4). Low self-efficacy was the most prominent barrier to deprescribing, founded on a perceived lack of evidence. Feasibility was an enabler when patient factors were present, particularly PwCF's experiences of reducing medications independently. Likewise, the presence of pharmacists in CF clinics and multidisciplinary team meetings were identified as facilitators. Inertia to continue entrenched prescribing habits and fear of adverse outcomes deterred deprescribing. Similarly, HCPs reported having little awareness of the need for deprescribing in daily practice, as their primary focus was on addressing acute problems.

CONCLUSIONS

Enhancing self-efficacy through evidence-based guidelines and increasing feasibility by fostering collaborative approaches among HCPs and PwCF may improve deprescribing practices in CF care. As evidence on the benefits and safety of deprescribing grows, it should be integrated into clinical guidelines to alleviate medication burden and improve quality of life for PwCF.

Prevalence of psychotropic medication dispensing to people living with cystic fibrosis in Australia: 2013-2022

OBJECTIVE

People living with cystic fibrosis (PwCF) are at increased risk of mental health conditions. There is little evidence addressing psychotropic medication use in PwCF. This study aimed to estimate the dispensing prevalence of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medication in PwCF in Australia between 2013 and 2022.

METHOD

A 10% random sample of Australian Pharmaceutical Benefits Scheme data was used to identify PwCF and their medications between 2013 and 2022. Annual prevalence of psychotropic medication dispensing was estimated using a 3-year rolling average, stratified by sex, age, and medication class.

RESULTS

Psychotropic medications were dispensed to 206/478 (41.3%) PwCF. Antidepressant and anxiolytic dispensing prevalence was highest in adult females, increasing from 201 5 by 50% to their peak in 2021 (antidepressants 36.8%; anxiolytics 12.3%). Psychostimulant prevalence was highest in adolescent males and increased over three-fold during the study period from 3.6% to 13.2%. The prevalence of antipsychotic medication was lower than other classes with adult females having the highest prevalence (3.1% and 5.8% in 201 5 and 2022 respectively). Hypnotic/sedative medications remained consistently low or decreased in all groups except male children, where it increased from 0.6% to 2.8% from 201 5 to 2022.

CONCLUSION

Psychotropic medication use is higher among Australian PwCF compared to the general population, with varying prevalence across age and sex groups. This is of interest due to complexities with CF comorbidities and potential medication influences and interactions. Future studies should investigate the reasons for psychotropic use disparities within PwCF with the aim to establish targeted guidelines and optimize outcomes.