A pilot study testing a medication algorithm to reduce polypharmacy

Mistler, Lisa A; Mellman, Thomas A.; Drake, Robert E.

doi:10.1136/qshc.2007.024471

Cited by 17 publications

(33 citation statements)

References 22 publications

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“…The first study involved adult patients admitted to a psychiatric unit of a regional hospital in the USA 40. The algorithm attempted to optimise single-drug regimens, where appropriate, and to eliminate redundant or ineffective medications.…”

Section: Resultsmentioning

confidence: 99%

Review of structured guides for deprescribing

2016

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Avoiding inappropriate polypharmacy has become increasingly recognised as a safety imperative for older patient care. Deprescribing is an active process of reviewing all medications being used by individual patients that prompts clinicians to consider which medications have unfavourable risk–benefit trade-offs in the context of illness severity, advanced age, multi-morbidity, physical and emotional capacity, life expectancy, care goals and personal preferences. Structured guides to deprescribing include algorithms, flow charts or tables which are patient-directed and aim to guide the clinician through sequential steps in deciding which medications should be targeted for discontinuation. In this narrative review, we describe seven structured deprescribing guides whose stated purpose included the reduction of polypharmacy, their use was not restricted to a single drug or drug class and they had undergone some form of efficacy testing. There was considerable heterogeneity in guide design and content, with some guides constituting little more than a set of principles while others entail detailed processes and sub-steps which addressed multiple determinants of drug appropriateness. Evidence of effectiveness for each guide was limited in that none have been evaluated in randomised controlled trials, that pilot or feasibility studies have involved relatively small patient samples, that intra-rater and inter-rater reliabilities have not been determined and that most have been studied in hospital settings. Which is most useful to clinicians is unknown in the absence of head-to-head comparisons. While most guides have face validity, more research is needed for determining effectiveness and ease of use in routine clinical practice, especially in primary care settings.

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Section: Resultsmentioning

confidence: 99%

Review of structured guides for deprescribing

2016

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“…The electronic search yielded a total of nine studies [7][8][9][10][11][12][13][14][15], focused on the impact of different clinical guideline implementation strategies on provider performance in specialist mental healthcare settings (Table 1).…”

Section: Impact Of Guideline Implementation Strategies On Process Outmentioning

confidence: 99%

“…Mistler et al [9] examined the feasibility of reducing redundant psychotropic medications by using an evidence-based algorithm for acute psychiatric inpatients already receiving coprescriptions of different psychotropic drugs. The algorithm was based on principles of collaborative care.…”

Section: Rate Of Polypharmacymentioning

confidence: 99%

Guideline implementation strategies for specialist mental healthcare

Girlanda

Fiedler

et al. 2013

Current Opinion in Psychiatry

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Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.

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“…This paper aims to describe the background and history as well as the concepts and the current status of comedication/ polypharmacy, focusing on the field of schizophrenia and depression. Generally speaking, comedication/ polypharmacy is a very common phenomenon for different reasons, and is difficult to reduce (Stahl, 1999a, b;Viola et al, 2004;Biancosino et al, 2005;Barbui et al, 2006;Russell et al, 2006;Megna et al, 2007;Pandurangi and Dalkilic, 2008;Thompson et al, 2008;Alda and Yatham, 2009;Glezer et al, 2009;Goldberg et al, 2009;McIntyre and Jerrell, 2009;Mistler et al, 2009;Shelton et al, 2010).…”

Section: Introductionmentioning

confidence: 98%

History, background, concepts and current use of comedication and polypharmacy in psychiatry

Möller

Seemüller

Schennach-Wolff

et al. 2013

Int. J. Neuropsychopharm.

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Based on a careful literature search a review is presented of the history, background, concepts and current use of comedication and polypharmacy in psychiatry. The pros and cons of comedication and polypharmacy are presented, as well as their apparent increase in recent times. Possible reasons for the increase of comedication/polypharmacy are described. Both the potential advantages as well as the potential risks are discussed. The one sided view that all comedication/polypharmacy is nothing but problematic is questioned. Comedication/polypharmacy seems to be, among others, the current answer to the well-known limited efficacy and effectiveness of current monotherapy treatment strategies.

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A pilot study testing a medication algorithm to reduce polypharmacy

Abstract: A collaborative approach to reducing polypharmacy may reverse the trend to add medications during hospitalization.

Cited by 17 publications

References 22 publications

Review of structured guides for deprescribing

Review of structured guides for deprescribing

Guideline implementation strategies for specialist mental healthcare

History, background, concepts and current use of comedication and polypharmacy in psychiatry

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