A multifactorial intervention to lower potentially inappropriate medication use in older adults in Argentina

Schapira, Marcelo; Calabró, Pablo; Montero‐Odasso, Manuel; Osman, Abdelhady; Guajardo, Maria Elena; Martínez, B.; Pollán, Javier; Cámera, Luis; Sassano, Miguel; Perman, Gastón

doi:10.1007/s40520-020-01582-4

Cited by 9 publications

(15 citation statements)

References 22 publications

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“…Across all five classes of drugs, patient acceptance was the lowest with TCA deprescribing (50%). These results conflict with an open-label study conducted in the ambulatory setting in Argentina, where TCA was significantly lower in the intervention group ( Schapira et al, 2021 ). Again, the email alert system and a “safe alternative” approach to deprescribing were the main differences between the two studies.…”

Section: Discussioncontrasting

confidence: 98%

“…The deprescribing efforts showed no significant differences between the usual care and intervention groups at any time point. This finding contradicts the results of a study by Schapira and colleagues that reported significant successful deprescribing of NSAID (73.08%) using multimodal interventions, including email alerts sent to prescribers at least 48-hrs before every appointment with a patient using PIM ( Schapira et al, 2021 ). An explanation of the conflicting results may be due to the deprescribing strategy used between the two studies.…”

Section: Discussioncontrasting

confidence: 86%

See 1 more Smart Citation

Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital

Bawazeer

Alsaad

Almalag

et al. 2022

Saudi Pharmaceutical Journal

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Section: Discussioncontrasting

confidence: 98%

Section: Discussioncontrasting

confidence: 86%

Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital

Bawazeer

Alsaad

Almalag

et al. 2022

Saudi Pharmaceutical Journal

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“…247 , 388 In Argentina, a multifaceted intervention including educational workshops, deprescribing algorithms and automated email alerts was found to successfully reduce inappropriate medications among 900 older adults (overall absolute reduction of 8.5% across eight classes of potentially inappropriate medications – relative reduction of 73% for non-steroidal anti-inflammatory drugs and 31% for benzodiazepines). 303 Also in Argentina, an email-linked behavioural intervention underpinned by social-norm feedback reduced inappropriate prescriptions and cost for cognitively impaired older adults. Physicians in the intervention group made fewer inappropriate prescriptions than physicians in the control group, mean 93.25 prescriptions (95% CI: 89.27–97.24) versus 98.99 (95% CI: 95.00–102.98).…”

Section: Resultsmentioning

confidence: 99%

Overuse of medications in low- and middle-income countries: a scoping review

Albarqouni

Palagama

Chai

et al. 2023

Bull World Health Organ

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Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.

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“…To that end, deprescribing has the potential not only to solve DRPs but also to minimize health costs and improve quality of life, while maintaining or even improving clinical outcomes. Studies addressing deprescribing showed a significant potential for reducing the use of potentially inappropriate medications and subsequent adverse outcomes reduction in various settings ( Kojima et al, 2012 ; Mckean et al, 2016 ; Cossette et al, 2017 ; Kimura et al, 2017 ; Wouters et al, 2017 ; Vasilevskis et al, 2019 ; Balsom et al, 2020 ; Dharmarajan et al, 2020 ; Kua et al, 2020 ; Schapira et al, 2020 ; McCarthy et al, 2022 ). Deprescribing-focused interventions showed promising results in the available literature.…”

Section: Introductionmentioning

confidence: 99%

“…Deprescribing-focused interventions showed promising results in the available literature. Studies addressing deprescribing in the hospital setting showed a significant decrease in PIMs use among older adults ( Mckean et al, 2016 ; Cossette et al, 2017 ; Kimura et al, 2017 ; Vasilevskis et al, 2019 ; Schapira et al, 2020 ). Similarly, with five studies conducted in nursing homes, physicians’ or pharmacists-directed reviews led to PIMs and subsequent adverse outcomes reduction ( Kojima et al, 2012 ; Wouters et al, 2017 ; Balsom et al, 2020 ; Dharmarajan et al, 2020 ; Kua et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

et al. 2023

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Background: Little research addressed deprescribing-focused medication optimization interventions while utilizing implementation science. This study aimed to develop a pharmacist-led medication review service with a deprescribing focus in a care facility serving patients of low income receiving medications for free in Lebanon followed by an assessment of the recommendations’ acceptance by prescribing physicians. As a secondary aim, the study evaluates the impact of this intervention on satisfaction compared to satisfaction associated with receiving routine care.Methods: The Consolidated Framework for Implementation Research (CFIR) was used to address implementation barriers and facilitators by mapping its constructs to the intervention implementation determinants at the study site. After filling medications and receiving routine pharmacy service at the facility, patients 65 years or older and taking 5 or more medications, were assigned into two groups. Both groups of patients received the intervention. Patient satisfaction was assessed right after receiving the intervention (intervention group) or just before the intervention (control group). The intervention consisted of an assessment of patient medication profiles before addressing recommendations with attending physicians at the facility. Patient satisfaction with the service was assessed using a validated translated version of the Medication Management Patient Satisfaction Survey (MMPSS). Descriptive statistics provided data on drug-related problems, the nature and the number of recommendations as well as physicians’ responses to recommendations. Independent sample t-tests were used to assess the intervention’s impact on patient satisfaction.Results: Of 157 patients meeting the inclusion criteria, 143 patients were enrolled: 72 in the control group and 71 in the experimental group. Of 143 patients, 83% presented drug-related problems (DRPs). Further, 66% of the screened DRPs met the STOPP/START criteria (77%, and 23% respectively). The intervention pharmacist provided 221 recommendations to physicians, of which 52% were to discontinue one or more medications. Patients in the intervention group showed significantly higher satisfaction compared to the ones in the control group (p < 0.001, effect size = 1.75). Of those recommendations, 30% were accepted by the physicians.Conclusion: Patients showed significantly higher satisfaction with the intervention they received compared to routine care. Future work should assess how specific CFIR constructs contribute to the outcomes of deprescribing-focused interventions.

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A multifactorial intervention to lower potentially inappropriate medication use in older adults in Argentina

Cited by 9 publications

References 22 publications

Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital

Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital

Overuse of medications in low- and middle-income countries: a scoping review

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

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