Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Reeve, Emily

doi:10.1002/jppr.1626

Cited by 74 publications

(83 citation statements)

References 56 publications

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“…86 Given the magnitude of overprescribing in older adults, deprescribing initiatives have been developed at an international level (IGRIMUP) 45 and national level in several countries, including Canada, the USA, and Australia, as a means to reduce excessive doses or to discontinue inappropriate drug therapy. A narrative review conducted by Reeve 87 categorises the available types of deprescribing tools, including those that provide general deprescribing guidance, those that are drugspecific, tools for identi fying potentially inappropriate medications (table), and those that are designed to engage patient participation. Tools developed to identify inappropriate medications can directly inform deprescribing and the deprescribing processes and often use inappropriate medication tools as one of their steps.…”

Section: The Deprescribing Process: Tools and Protocolsmentioning

confidence: 99%

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens

Rochon

Petrovic

Cherubini

et al. 2021

The Lancet Healthy Longevity

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Polypharmacy is very common in older adults and increases the risk of inappropriate and unsafe prescribing for older adults. Older adults, particularly women (who make up the majority of this age group), are at the greatest risk for drug-related harm. Therefore, optimising drug prescribing for older people is very important. Identifying potentially inappropriate medications and opportunities for judicious deprescribing processes are intrinsically linked, complementary, and essential for optimising medication safety. This Review focuses on optimising prescribing for older adults by reducing doses or stopping drugs that are potentially harmful or that are no longer needed. We explore how sex (biological) and gender (sociocultural) factors are important considerations in safe drug prescribing. We conclude by providing a practical approach to optimising medication safety that clinicians can routinely apply to the care of their older patients, highlighting how sex and gender considerations inform medication decision making.

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Section: The Deprescribing Process: Tools and Protocolsmentioning

confidence: 99%

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens

Rochon

Petrovic

Cherubini

et al. 2021

The Lancet Healthy Longevity

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“…A recent study conducted in Canada suggested that pharmacist-led deprescribing focused medication review minimised unnecessary and potentially harmful medications (30). There have been several tools to support HCPs to assuredly deprescribe harmful or unwanted medications (31). However, it is unknown as to which tools are more important to effectively deprescribing and improving patient outcomes particular to the Ethiopian context.…”

Section: Discussionmentioning

confidence: 99%

Deprescribing practice in a resource-limited setting: Healthcare providers’ insights

Tegegn

Gebresillassie

Erku

et al. 2020

Preprint

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Aims: Inappropriate polypharmacy poses adverse drug events, mortality, and high healthcare costs. Deprescribing could minimise inappropriate polypharmacy and the consequence thereof. This study aims to evaluate healthcare providers' (HCPs) attitudes toward, and experiences with the deprescribing practice. Methods: An institution-based cross-sectional study was conducted among HCPs at the University of Gondar Referral Hospital, Ethiopia. Perception of HCPs on deprescribing was measured by Linsky et al. validated tool. This tool has five dimensions that could affect HCPs' decision to discontinue medications intentionally. One-way ANOVA was used to test the association between socio-demographic variables and their perception of deprescribing decisions. Results: Of 85 HCPs approached, about 82 HCPs with a 96.5% response rate were included in the final analysis of this study. Most HCPs (87%) were less likely or not at all to be affected by a strong relationship between HCPs and their patients to make a deprescribing decision. However, HCPs believed that formal education, significant physical health conditions, objective response to the clinical endpoint of the medication (e.g., blood pressure), and on-the-job experience profoundly influenced them to decide on deprescribing. According to the post-hoc analysis of one-way ANOVA, clinical pharmacists seemed to have a better attitude toward deprescribing decisions compared to physicians. (p = 0.025). Conclusion: HCPs' decision to discontinue a medication could be multifactorial, and HCPs could be influenced by education level and their experience to discontinue a medication intentionally. A therapy-specific deprescribing algorithm, multidisciplinary collaboration, and continuous education development should be instituted to guide HCPs in the deprescribing decision process.

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“…We contacted GPs in two German regions (Marburg and Hannover) using established relationships, either through teaching assignments or through primary care research networks. Study staff helped participating GPs to install the withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes [3]. Yet physicians find it difficult to deprescribe as decisions need to be based on complex interacting factors, and medical evidence is often uncertain [4].…”

Section: Training and Recruitmentmentioning

confidence: 99%

MediQuit, an Electronic Deprescribing Tool for Patients on Polypharmacy: Results of a Feasibility Study in German General Practice

et al. 2021

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Background Deprescribing is an important task for general practitioners (GPs) in the face of risky polypharmacy. The electronic tool "MediQuit" was developed to guide GPs and patients through a deprescribing consultation that entails a drug-selection phase, shared decision making, and advice on safe implementation. Objectives A pilot study was conducted to determine the target group of patients that is selected for consultation and to assess the impact, patient involvement, and feasibility of the tool. Methods This was an uncontrolled pilot study. GPs from two German regions were invited to use MediQuit in consultations with a view to deprescribing one drug, if appropriate. They selected patients on the basis of broad inclusion criteria. Collected data entailed participants' characteristics, patients' medication lists, deprescribed drugs, and feasibility assessments. Patients were contacted shortly after the consultation and again after 4 weeks. Results In total, 16 GPs agreed to participate, of whom ten actually performed deprescribing consultations. They selected 41 predominately older patients on excessive polypharmacy. Deprescribing was achieved in 70% of consultations in agreement with patients. Drugs deprescribed were symptom-lowering and preventive drugs (mainly anatomical therapeutic chemical classes A and C). GPs found MediQuit useful in initiating communication on this issue and enhancing deliberations for a deprescribing decision. The median consultation length was 15 min (interquartile range 10-20). At follow-up, GPs and patients infrequently disagreed on which drug(s) was discontinued, and GPs rated patient involvement higher than did patients themselves. Discussion MediQuit assists in identifying concrete deprescribing opportunities, patient involvement, and shared decision making. The three-step deprescribing procedure is well-accepted once initial organizational efforts are overcome. After revision, further studies are needed to enhance the quality of evidence on acceptance and effectiveness.

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Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice

Cited by 74 publications

References 56 publications

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens

Deprescribing practice in a resource-limited setting: Healthcare providers’ insights

MediQuit, an Electronic Deprescribing Tool for Patients on Polypharmacy: Results of a Feasibility Study in German General Practice

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