The use of inappropriate medication is an increasing problem among the elderly, leading to hospitalizations, mortality, adverse effects, and lower quality of life (QoL). Deprescribing interventions (e.g., medication reviews (MRs)) have been examined as a possible remedy for this problem. In order to be able to evaluate the potential benefits and harms of a deprescribing intervention, quality of life (QoL) has increasingly been used as an outcome. The sensitivity of QoL measurements may, however, not be sufficient to detect a change in specific disease symptoms, e.g., a flair-up in symptoms or relief of side effects after deprescribing. Using symptom assessments as an outcome, we might be able to identify and evaluate the adverse effects of overmedication and deprescribing alike. The objective of this study was to explore whether symptom assessment is a feasible and valuable method of evaluating outcomes of MRs among the elderly in nursing homes. To the best of our knowledge, this has not been investigated before. We performed a feasibility study based on an experimental design and conducted MRs for elderly patients in nursing homes. Their symptoms were registered at baseline and at a follow-up 3 months after performing the MR. In total, 86 patients, corresponding to 68% of the included patients, received the MR and completed the symptom questionnaires as well as the QoL measurements at baseline and follow-up, respectively. Forty-eight of these patients had at least one deprescribing recommendation implemented. Overall, a tendency towards the improvement of most symptoms was seen after deprescribing, which correlated with the tendencies observed for the QoL measurements. Remarkably, deprescribing did not cause a deterioration of symptoms or QoL, which might otherwise be expected for patients of this age group, of whom the health is often rapidly declining. In conclusion, it was found that symptom assessments were feasible among nursing home residents and resulted in additional relevant information about the potential benefits and harms of deprescribing. It is thus recommended to further explore the use of symptom assessment as an outcome of deprescribing interventions, e.g., in a controlled trial.
The Global Initiative for Asthma (GINA) has presented a shift in pharmacological asthma treatment. The objective of this study was to explore factors influencing a successful switch to a new asthma treatment approach with a focus on asthma patients’ attitudes toward treatment change and supportive initiatives. This study was performed as a case study involving a quantitative questionnaire and a qualitative semi-structured interview. A total of 284 responses were collected from the questionnaire, and 141 responses were included. The results showed that asthma patients thought that effectiveness of the new treatment approach, doctor recommendation, and knowledge of the new treatment approach were the most important factors influencing treatment change considerations. Nine interviews were conducted where the main themes were barriers to a shift in asthma treatment, such as effects and side effects of the new treatment, the role of the general practitioner (GP) and conflicts in agreeing on a treatment plan; as well as facilitators to a shift in asthma treatment, such as trust in the GP and easier inhaler use. We found several supportive initiatives, such as consultation with the GP, handing out information leaflets and a consultation at the pharmacy. In conclusion, this study uniquely identified factors that may influence successful treatment shifts in asthma patients that may be instrumental in understanding similar situations in other pharmacological settings.
Background: The increasing population of elderly individuals had led to an increasing number of polypharmacy patients. Polypharmacy increases the risk of adverse drug reactions and hospitalization. One means to combat polypharmacy involves performing medication reviews, which can be conducted by different methods and stakeholders. Objective: The study objective was to explore the value of involving different health-care professions in medication reviews at an equal and closely integrated collaborative physical meeting for elderly individuals at a long-term care facility. A specific focus was to explore the contributions and opinions of the different health-care professionals regarding the medication review process. Materials and Methods: A single case study was applied to perform an in-depth study of a group of health-care professionals performing medication reviews in collaboration. Hence, the study was performed in two settings: 1) the practical execution of medication reviews at a long-term care facility in an interprofessional team and 2) qualitative semi-structured interviews conducted to explore the forms of work done by different professional groups in performing an interdisciplinary medication review. Results: Forty-nine residents from a long-term care facility were included in the study and were offered a medication review. In total, they reported 573 prescriptions, for which 150 changes were recommended by the interprofessional team. At the 3- and 8-month follow-ups, 30.0% and 49.5% of the accepted recommendations had been implemented, respectively. According to the interview, the results reveal that the interdisciplinarity of the interprofessional team was perceived as a great advantage to the results of the medication reviews. Conclusion: The results suggest that performing medication reviews in interprofessional collaboration improves the perceived quality of such reviews with a more complete picture of the residents and their medications, leading to more personalized recommendations and resulting in optimized medication reviews for the individual patients.
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