Deprescribing perceptions and practice reported by multidisciplinary hospital clinicians after, and by medical students before and after, viewing an e-learning module

Ng, Brendan; Duong, Mai; Lo, Sarita; Couteur, David G. Le; Hilmer, Sarah N.

doi:10.1016/j.sapharm.2021.03.002

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…44,45 Introducing prescribing education in medical schools and continuing medical education programs for health professionals can improve the skills and confidence of healthcare professionals managing medication-related problems in older people. 36,46,47 At the healthcare system level, specialist medical colleges and other professional and consumer groups have important roles in advocacy and can influence policies related to health literacy and coordination between primary, secondary and tertiary health care providers. Therefore, a concerted effort from all levels of healthcare systems will be needed to make a significant impact on reducing inappropriate medication use.…”

Section: Healthcare Professionalsmentioning

confidence: 99%

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice. Deprescribing is an established management strategy to minimize polypharmacy and potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on the success of deprescribing interventions in research and practice. Management strategies that target all levels of the healthcare system are required to overcome these challenges. Future studies may consider large multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on clinical outcomes.

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Section: Healthcare Professionalsmentioning

confidence: 99%

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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“…Few robust interprofessional deprescribing education programs involving multiple HCPs have been published. [15][16][17] These programs have been delivered as workshops or online modules but have not targeted all relevant HCPs and students involved in deprescribing.…”

Section: Discussionmentioning

confidence: 99%

Supporting Interprofessional Collaboration in Deprescribing: Needs Assessment for an Education Program

Kennie‐Kaulbach

Gormley

McSweeney-Flaherty

et al. 2022

J Contin Educ Health Prof

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Introduction : Deprescribing is a complex process involving patients and healthcare providers. The aim of the project was to examine the learning needs and preferences of healthcare providers and students to inform the development of an interprofessional deprescribing education program. Methods : An online survey of pharmacists, nurses, nurse practitioners, family physicians, and associated students practicing or studying in Nova Scotia was conducted. Respondents were recruited by purposive and snowball sampling to have at least five respondents within each professional/student group. Questions captured participant's self-reported comfort level and professional role for 12 deprescribing tasks and their learning preferences. Results : Sixty-nine respondents (46 healthcare providers and 23 students) completed the questionnaire. Average comfort levels for all 12 deprescribing tasks ranged from 40.22 to 78.90 of 100. Respondents reported their preferred deprescribing learning activities as watching videos and working through case studies. Healthcare providers preferred to learn asynchronously online, while students preferred a mix of online and in-person delivery. Discussion : Learning needs related to deprescribing tasks and roles were identified, as well as preferences for format and delivery of education. Development of an education program that can provide a shared understanding of collaborative deprescribing tailored to learner preferences may improve deprescribing in practice.

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“…Our intervention bundle was designed through literature review, expert consensus, observational research and subsequent usability and field testing with key stakeholders including hospital clinicians, GPs and consumers 31–38 . The intervention bundle, once developed, was promoted to hospital clinicians via departmental and ward meetings, education sessions and training workshops.…”

Section: Methodsmentioning

confidence: 99%

“…An online education module outlining the importance of reviewing polypharmacy in older inpatients, roles of the multidisciplinary team and key resources was available on the platform routinely used to train hospital staff (NSW Health My Health Learning). 35 F I G U R E 1 Screenshot of the Drug Burden Index MPage in electronic medical records…”

Section: Education Module On Polypharmacy In Older Inpatientsmentioning

confidence: 99%

A stewardship program to facilitate anticholinergic and sedative medication deprescribing using the drug burden index in electronic medical records

Masnoon

Hilmer

2022

Brit J Clinical Pharma

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Aims The drug burden index (DBI) measures a person's total exposure to anticholinergic and sedative medications, which are commonly associated with harm. Through incorporating the DBI in electronic medical records (eMR) and implementing a DBI stewardship program, we aimed to determine (i) uptake of the steward's recommendations to deprescribe anticholinergic and/or sedative drugs by the medical team and (ii) whether accepted recommendations were actioned in hospital or recommended for follow‐up by the General Practitioner post‐discharge. Methods A single‐arm, non‐randomised feasibility study was performed at an Australian tertiary referral metropolitan hospital. The stewardship pharmacist reviewed eMRs of patients aged ≥75 years with DBI scores > 0, during admission. The steward identified and discussed potential opportunities to deprescribe anticholinergic and/or sedative medications with the medical registrars. Results Amongst 256 patients reviewed, the steward made 170 recommendations for 117 patients. Registrars agreed with 141 recommendations (82.9%) for 95 patients (81.2%), and actioned 115 deprescribing recommendations for 80 patients, most commonly for antidepressants and opioids. The 115 actioned recommendations resulted in 125 changes, with 44 changes to the inpatient drug chart and 81 additional changes recommended post‐discharge in the discharge summary. Conclusion Opportunities exist for deprescribing anticholinergic and sedative medications in older inpatients and a DBI stewardship program may help implement these. It is important to capture different outcomes of deprescribing interventions, including in‐hospital medication changes, recommendations in the Discharge Summary, sustainability of deprescribing and clinical outcomes.

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Deprescribing perceptions and practice reported by multidisciplinary hospital clinicians after, and by medical students before and after, viewing an e-learning module

Cited by 13 publications

References 34 publications

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Supporting Interprofessional Collaboration in Deprescribing: Needs Assessment for an Education Program

A stewardship program to facilitate anticholinergic and sedative medication deprescribing using the drug burden index in electronic medical records

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