Deprescribing for all: a narrative review identifying inappropriate polypharmacy for all ages in hospital settings

Elbeddini, Ali; Sawhney, Monakshi; Tayefehchamani, Yasamin; Yılmaz, Zekiye; Elshahawi, Ahmed; Villegas, Josiah Josh; Cruz, Janelyn Dela

doi:10.1136/bmjoq-2021-001509

Cited by 8 publications

(14 citation statements)

References 29 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Introductionmentioning

confidence: 99%

“…12,13 The evidence from these studies underscores the importance of identifying factors for sustainable deprescribing interventions and expanding them to both younger populations and patients seen in a variety of health settings, including those that do not employ a staff pharmacist. 14 Past research indicates the value of patient-centeredness and shared decision-making focused on medication use; 15 however, there are communication barriers between members of the patientclinician-pharmacist triad that challenge effective deprescribing interventions. 16 Consequently, understanding how to engage patients, clinicians, and pharmacists in communication concerning deprescribing in a unified and patient-centered manner is important for designing effective deprescribing interventions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Lukacena

Keck

Freeman

et al. 2022

Therapeutic Advances in Drug Safety

View full text Add to dashboard Cite

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18 years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and pharmacists, and the revised Patients’ Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants ( n = 65 identified as female and n = 74 as White/Caucasian) with a mean age of 50.4 years [standard deviation (SD) = 15.5]. Participants reported taking an average of 8.4 daily medications (SD = 6.1). Most participants reported effective communication with clinicians and pharmacists (66.9%) and expressed willingness to stop one of their medications if their clinician said it was possible (83.5%). Predictors of willingness to accept deprescribing were older age [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.45–6.2], college/graduate degree (OR = 55.25, 95% CI = 5.74–531.4), perceiving medications as less appropriate (OR = 8.99, 95% CI = 1.1–73.62), and perceived effectiveness of communication with the clinician or pharmacist (OR = 4.56, 95% CI = 0.85–24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept deprescribing of medications when their doctor said it was possible. Targeted strategies to facilitate communication within the patient–primary care clinician–pharmacist triad that consider patient characteristics such as age and education level may be necessary ingredients for developing successful deprescribing interventions. Plain Language Summary Are patients willing to accept stopping medications? Sometimes, medicines that a patient takes regularly become inappropriate. In other words, the risks of adverse effects might be greater than a medicine’s potential benefits. The decision to stop such medicines should involve the patient and consider their preferences. We surveyed a group of patients taking multiple medicines to see how they felt about having those medicines stopped. We also asked patients whether and how much they talk to their primary care clinician and pharmacists about their medicines. To qualify for this study, patients had to be at least 18 years old and to take three or more medicines daily; they also needed to speak English. Participants provided demographic information and answered questions about their medicines, their communication with primary care clinicians and pharmacists, and their feelings about having one or more of their medicines stopped. We recruited 107 people and were able to use responses from 103 of them. Their average age was 50 years; 65 of them identified as female, and 75 identified as White/Caucasian. Most of our participants mentioned having conversations with primary care clinicians and pharmacists and said they would be willing to stop a medication if their clinician said it was possible. Older participants, those with more years of education, those who thought their medications might lead to side effects, and those who communicated with their clinician or pharmacists were more willing to have one of their medicines stopped. Our results indicate that patient characteristics and communication with clinicians and pharmacists are factors to consider when designing interventions to reduce the use of inappropriate medicines.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Lukacena

Keck

Freeman

et al. 2022

Therapeutic Advances in Drug Safety

View full text Add to dashboard Cite

show abstract

“…This could especially be pertinent to the prevention and management of delirium in patients with pre-existing cognitive impairments in phenotypes F and G [ 33 ], dealing with problems of polypharmacy by thoroughly reviewing prescriptions in individuals with multimorbidity, e.g. in phenotype F, [ 34 ] and planning early rehabilitation for patients with frailty and functional impairments [ 35 ]. For example, the 82-year-old patient with frailty (CFS 6) who requires only limited ventilatory but no other organ support (phenotype F) may substantially benefit from these interventions to return to the previous level of functioning.…”

Section: Discussionmentioning

confidence: 99%

Clustering analysis of geriatric and acute characteristics in a cohort of very old patients on admission to ICU

et al. 2022

View full text Add to dashboard Cite

Purpose The biological and functional heterogeneity in very old patients constitutes a major challenge to prognostication and patient management in intensive care units (ICUs). In addition to the characteristics of acute diseases, geriatric conditions such as frailty, multimorbidity, cognitive impairment and functional disabilities were shown to influence outcome in that population. The goal of this study was to identify new and robust phenotypes based on the combination of these features to facilitate early outcome prediction. Methods Patients aged 80 years old or older with and without limitations of life-sustaining treatment and with complete data were recruited from the VIP2 study for phenotyping and from the COVIP study for external validation. The sequential organ failure assessment (SOFA) score and its sub-scores taken on admission to ICU as well as demographic and geriatric patient characteristics were subjected to clustering analysis. Phenotypes were identified after repeated bootstrapping and clustering runs. Results In patients from the VIP2 study without limitations of life-sustaining treatment ( n = 1977), ICU mortality was 12% and 30-day mortality 19%. Seven phenotypes with distinct profiles of acute and geriatric characteristics were identified in that cohort. Phenotype-specific mortality within 30 days ranged from 3 to 57%. Among the patients assigned to a phenotype with pronounced geriatric features and high SOFA scores, 50% died in ICU and 57% within 30 days. Mortality differences between phenotypes were confirmed in the COVIP study cohort ( n = 280). Conclusions Phenotyping of very old patients on admission to ICU revealed new phenotypes with different mortality and potential need for anticipatory intervention. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06868-x.

show abstract

“…3 In further research initiatives, this definition has included dose changes of medications, 4 as well as population of patients other than older adults such as children and patients with psychiatric disorders as they have been identified as in need of deprescribing. 25 Moreover, populations other than older adults have been identified as in need of deprescribing, such as children and psychiatric patients. 7,26 Multiple deprescribing frameworks have been proposed and evaluated.…”

Section: Concept Process and Target Populationmentioning

confidence: 99%

“…With the development of research in this area, this approach has been clarified to propose a supervised, proactive, comprehensive and patient‐centred intervention 23 with several definitions and frameworks been developed 24 . One of the most systematic definitions has been provided by Reeve et al, who defined deprescribing as “the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes.” 3 In further research initiatives, this definition has included dose changes of medications, 4 as well as population of patients other than older adults such as children and patients with psychiatric disorders as they have been identified as in need of deprescribing 25 . Moreover, populations other than older adults have been identified as in need of deprescribing, such as children and psychiatric patients 7,26 .…”

Section: Concept Process and Target Populationmentioning

confidence: 99%

Inappropriate polypharmacy management versus deprescribing: A review on their relationship

Zidan

Awaisu

2023

Basic Clin Pharma Tox

View full text Add to dashboard Cite

Medication burden and polypharmacy are highly prevalent among patients with multimorbidity. There have been multiple initiatives to overcome polypharmacy and medication burden in patients with multimorbidity. These initiatives have evolved over time as effective in reducing the negative health consequences of polypharmacy. In recent years, the concept and practice of deprescribing has emerged and gained popularity as an efficient comprehensive approach to manage polypharmacy and ultimately improve health outcomes. Clinicians and researchers with interest in deprescribing view it as a novel and unique strategy that should be a part of effective prescribing process. However, other traditional polypharmacy management strategies such as drug review and medication therapy management still coexist. It is intriguing if deprescribing is considered as a type of these strategies or not. This narrative mini‐review explored published literature in an effort to ascertain the differences and similarities between deprescribing and other prominent polypharmacy management interventions. It is clear that there is an overlap between deprescribing and inappropriate polypharmacy management. This is represented by focusing on multimorbid older adults, using similar explicit and implicit tools and having drug review as the core principle of both approaches. This overlap has probably made deprescribing considered as one of polypharmacy management approaches.

show abstract

Deprescribing for all: a narrative review identifying inappropriate polypharmacy for all ages in hospital settings

Cited by 8 publications

References 29 publications

Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Clustering analysis of geriatric and acute characteristics in a cohort of very old patients on admission to ICU

Inappropriate polypharmacy management versus deprescribing: A review on their relationship

Contact Info

Product

Resources

About