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Rodríguez-Ramallo H, Báez-Gutiérrez N, Villalba-Moreno Á, Jaramillo Ruiz D, Santos-Ramos B, Prado-Mel E, Sanchez-Fidalgo S. Reducing the drug burden of sedative and anticholinergic medications in older adults: a scoping review of explicit decision criteria. Arch Gerontol Geriatr 2024; 121:105365. [PMID: 38364710 DOI: 10.1016/j.archger.2024.105365] [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: 12/10/2023] [Revised: 01/27/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To describe the extent, characteristics, and knowledge gaps regarding explicit decision criteria for deprescribing drugs with anticholinergic or sedative properties (Ach/Sed) in older adults. DESIGN Scoping review. SETTING AND PARTICIPANTS Original studies, clinical trial protocols, grey literature, and Summaries of Product Characteristics. METHODS Searches targeting explicit decision criteria for deprescribing Ach/Sed were performed across MEDLINE, EMBASE, CINAHL, and Web of Science, including trial registries (clinicaltrials.gov, ICTRP, EU-CTR, ANZCTR) for pertinent articles, study protocols. Additionally, to encompass non-traditional or 'grey literature' sources, Google searches and relevant agency websites were explored, alongside the summary of product characteristics for Ach/Sed. RESULTS The initial literature search identified 8,192 unique data sources. After review, 188 original articles or books, 79 internet sources, and 127 SmPCs were included. Examining these sources for explicit criteria for 154 Ach/Sed, overall, 1,271 explicit criteria guidance for identifying clinical scenarios warranting deprescription of Ach/Sed across 145/154 Ach/Sed were identified. These criteria were identified mainly from qualitative research and Summaries of Product Characteristics. Additionally, 455 criteria-based recommendations suggesting approaches for tapering implementation across 76/154 Ach/Sed were identified, mostly from sources classified as expert opinions. Significant heterogeneity was found across the approaches for tapering Ach/Sed. CONCLUSIONS This scoping review provides a comprehensive overview of the literature providing guidance for clinical scenarios where Ach/Sed should be deprescribed and highlights the existing knowledge gaps regarding comprehensive guidance on tapering these drugs which warranties future research and development.
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Affiliation(s)
- Hector Rodríguez-Ramallo
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain; Clinical Unit of Pneumology and Thoracic Surgery, Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | | | | | - Didiana Jaramillo Ruiz
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain; Andalusian Public Foundation for Health Research Management of Seville, Seville, Spain
| | | | - Elena Prado-Mel
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain
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Ashkanani FZ, Rathbone AP, Lindsey L. The role of pharmacists in deprescribing benzodiazepines: A scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100328. [PMID: 37743854 PMCID: PMC10511800 DOI: 10.1016/j.rcsop.2023.100328] [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: 05/23/2023] [Revised: 07/14/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Polypharmacy can increase the risk of adverse drug events, hospitalisation, and unnecessary healthcare costs. Evidence indicates that discontinuing certain medications, such as benzodiazepines, can improve health outcomes, by resolving adverse drug effects. This scoping review aims to explore the pharmacists' role in deprescribing benzodiazepines. Method A scoping review has been conducted to distinguish and map the literature, discover research gaps, and focus on targeted areas for future studies and research. A systematic search strategy was conducted to identify relevant studies from PubMed, Medline, and EMBASE databases. The eligibility criteria involved studies that focused on the role of pharmacists in benzodiazepine deprescribing, quantitative and qualitative studies conducted in humans, full-text articles published in English. Results Twenty studies were identified, revealing three themes: 1) pharmacists' involvement in benzodiazepine deprescribing, 2) the impact of their involvement, and 3) obstacles impeding the process. Pharmacists involved in deprescribing procedures, mainly through completing medication reviews, collaborative work with other healthcare providers, and education. Pharmacists' involvement in benzodiazepine deprescribing intervention led to better health and economic outcomes. Withdrawal symptoms after medication discontinuation, dependence on medication, and lack of time and guidelines were identified in the literature as barriers to deprescribing. Conclusion Pharmacists' involvement in deprescribing benzodiazepines is crucial for optimizing medication therapy. This scoping review examines the pharmacists' role in benzodiazepine deprescribing. The findings contribute to enhancing healthcare outcomes and guiding future research in this area.
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Affiliation(s)
- Fatemah Zakariya Ashkanani
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
| | - Adam Pattison Rathbone
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
| | - Laura Lindsey
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, Tyne and Wear NE2 7RU, United Kingdom
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Reeve E, Moriarty F, Nahas R, Turner JP, Kouladjian O'Donnell L, Hilmer SN. A narrative review of the safety concerns of deprescribing in older adults and strategies to mitigate potential harms. Expert Opin Drug Saf 2017; 17:39-49. [PMID: 29072544 DOI: 10.1080/14740338.2018.1397625] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION 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. These are discussed in relation to medications in general, with some examples of medication classes used to illustrate the potential safety concerns. The majority of these harms can be minimized or even prevented by using a patient-centered, structured deprescribing process with planning, tapering and close monitoring during, and after medication withdrawal. EXPERT OPINION More research is needed into the safety concerns of deprescribing, however, avenues exist during drug development and post-marketing surveillance to gain knowledge on this topic. Questions remain about when it is suitable to discontinue certain medications/medication classes and there is uncertainty about the harms and benefits of both medication continuation and discontinuation in complex older adults.
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Affiliation(s)
- Emily Reeve
- a Cognitive Decline Partnership Centre, Ageing and Pharmacology, Kolling Institute of Medical Research, School of Medicine , University of Sydney , St Leonards , NSW , Australia.,b Geriatric Medicine Research , Dalhousie University Faculty of Medicine , Halifax , NS , Canada.,c Faculty of Health Professions - College of Pharmacy , Dalhousie University , Halifax , NS , Canada
| | - Frank Moriarty
- d HRB Centre for Primary Care Research, Department of General Practice , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Rayan Nahas
- e Departments of Aged Care and Clinical Pharmacology , Royal North Shore Hospital , Saint Leonards , NSW , Australia
| | - Justin P Turner
- f Centre de recherché , Universite de Montreal Institut universitaire de geriatrie de Montreal , Montreal , QC , Canada.,g Faculte de pharmacie , Universite de Montreal , Montreal , QC , Canada
| | - Lisa Kouladjian O'Donnell
- a Cognitive Decline Partnership Centre, Ageing and Pharmacology, Kolling Institute of Medical Research, School of Medicine , University of Sydney , St Leonards , NSW , Australia.,e Departments of Aged Care and Clinical Pharmacology , Royal North Shore Hospital , Saint Leonards , NSW , Australia
| | - Sarah N Hilmer
- a Cognitive Decline Partnership Centre, Ageing and Pharmacology, Kolling Institute of Medical Research, School of Medicine , University of Sydney , St Leonards , NSW , Australia.,e Departments of Aged Care and Clinical Pharmacology , Royal North Shore Hospital , Saint Leonards , NSW , Australia
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Schjøtt J. Challenges in psychopharmacology: a drug information centre perspective. J Clin Pharm Ther 2016; 41:4-6. [DOI: 10.1111/jcpt.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Affiliation(s)
- J. Schjøtt
- Section of Clinical Pharmacology; Laboratory of Clinical Biochemistry; Haukeland University Hospital; Bergen Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest); Haukeland University Hospital; Bergen Norway
- Department of Clinical Science; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
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Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol 2015; 78:738-47. [PMID: 24661192 DOI: 10.1111/bcp.12386] [Citation(s) in RCA: 239] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/20/2014] [Indexed: 12/30/2022] Open
Abstract
Inappropriate use of medication is widespread, especially in older people, and is associated with risks, including adverse drug reactions, hospitalization and increased mortality. Optimization of appropriate medication use to minimize these harms is an ongoing challenge in healthcare. The term 'deprescribing' has been used to describe the complex process that is required for safe and effective cessation of medication. Patients play an important role in their own health and, while they may complain about the number of medications they have to take, they may also be reluctant to cease a medication when given the opportunity to do so. A review of previously proposed deprescribing processes and relevant literature was used to develop the patient-centred deprescribing process, which is a five-step cycle that encompasses gaining a comprehensive medication history, identifying potentially inappropriate medications, determining whether the potentially inappropriate medication can be ceased, planning the withdrawal regimen (e.g. tapering where necessary) and provision of monitoring, support and documentation. This is the first deprescribing process developed using knowledge of the patients' views of medication cessation; it focuses on engaging patients throughout the process, with the aim of improving long-term health outcomes. Despite a comprehensive review of the literature, there is still a lack in the evidence base on which to conduct deprescribing. The next step in broadening the evidence to support deprescribing will be to test the developed process to determine feasibility in the clinical setting.
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Affiliation(s)
- Emily Reeve
- Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Reeve E, Gnjidic D, Hilmer S. The role of the OncPal deprescribing guideline in end-of-life care. Support Care Cancer 2014; 23:899. [PMID: 25245777 DOI: 10.1007/s00520-014-2445-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Emily Reeve
- University of Sydney, St Leonards, NSW, Australia,
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Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People's attitudes, beliefs, and experiences regarding polypharmacy and willingness to Deprescribe. J Am Geriatr Soc 2013; 61:1508-14. [PMID: 24028356 DOI: 10.1111/jgs.12418] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To capture people's attitudes, beliefs, and experiences regarding the number of medications they are taking and their feelings about stopping medications. DESIGN Administration of a validated questionnaire. SETTING Multidisciplinary ambulatory consulting service at the Royal Adelaide Hospital. PARTICIPANTS Participants were individuals aged 18 and older (median 71.5) taking at least one regular prescription medication; 100 participants completed all items of the questionnaire, 65 of whom were aged 65 and older. MEASUREMENTS Participants were administered the 15-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire. RESULTS Participants were taking an average of 10 different prescription and nonprescription (including complementary), regular and as-needed medications. More than 60% felt that they were taking a "large number" of medications, and 92% stated that they would be willing to stop one or more of their current medications if possible. Number of regular medications, age, and number of medical conditions were not found to be correlated with willingness to stop a medication. The findings were similar in older and younger participants. CONCLUSION This study has shown that a cohort of mostly older adults were largely accepting of a trial of cessation of medication(s) that their prescriber deemed to be no longer required. Because few factors were associated with willingness to cease medications, all patients should be individually evaluated for deprescribing.
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Affiliation(s)
- Emily Reeve
- Sansom Institute, University of South Australia, Adelaide, SA, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
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Schjøtt J, Raknes G. Håndtering av seponeringsreaksjoner. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:37-8. [DOI: 10.4045/tidsskr.09.1088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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