Drug Prescribing in the Elderly Receiving Home Care

Tsao, Chien‐Han; Tsai, Chin‐Feng; Lee, Yuan‐Ti; Weng, Mao-Chung; Lee, Huei-Chao; Lin, David T.W.; Chen, Chun‐Chieh; Lee, Meng-Chih; Chen, Shiuan‐Chih

doi:10.1016/j.amjms.2016.04.015

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…Deprescribing has become a priority today because polypharmacy can increase the risk of drug-related problems [1][2][3][4][5][6][7][8]. Deprescribing can be defined as a patient-centered process conducted under the supervision of a healthcare professional for discontinuing or reducing the dose of medications that are no longer needed, for which the risks outweigh the benefits, or that are incompatible with the goals of care [9][10][11].…”

Section: Deprescribing: a Topical Issuementioning

confidence: 99%

Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

Nizet,

Evin,

Brociero

et al. 2023

BMC Geriatr

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Background Deprescribing, defined as discontinuing or reducing the dose of medications that are no longer needed or for which the risks outweigh the benefits is a way to reduce polypharmacy. In 2022, the US Deprescribing Research Network (USDeN) published recommendations concerning the measurement of outcomes for deprescribing intervention studies. The objectives of this systematic review were to identify the outcome categories used in deprescribing intervention trials and to relate them to the previously published recommendations. Methods We searched MEDLINE, Embase, PsychInfo, and the Cochrane library from January 2012 through January 2022. Studies were included if they were randomized controlled trials evaluating a deprescribing intervention. After data extraction, outcomes were categorized by type: medication outcomes, clinical outcomes, system outcomes, implementation outcomes, and other outcomes based on the previously published recommendations. Results Thirty-six studies were included. The majority of studies focused on older adults in nursing homes and targeted inappropriate medications or polypharmacy. In 20 studies, the intervention was a medication review; in seven studies, the intervention was educational or informative; and three studies based their intervention on motivational interviewing or patient empowerment. Thirty-one studies presented a medication outcome (primary outcome in 26 studies), 25 a clinical outcome, 18 a system outcome, and seven an implementation outcome. Only three studies presented all four types of outcomes, and 10 studies presented three types of outcomes. Conclusions This review provides an update on the implementation of gold standard deprescribing studies in clinical practice. Implementation outcomes need to be developed and specified to facilitate the implementation of these practices on a larger scale and clinical outcome need to be prioritized. Finally, this review provides new elements for future real-life deprescribing studies.

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Section: Deprescribing: a Topical Issuementioning

confidence: 99%

Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

Nizet,

Evin,

Brociero

et al. 2023

BMC Geriatr

View full text Add to dashboard Cite

show abstract

“…Studies show that more than half of older adults take five or more medications concurrently, which is a geriatric syndrome called polypharmacy [1]. Polypharmacy can increase the risk of medicationrelated problems such as the use of potentially inappropriate medications (PIMs) [2][3][4][5][6][7], medication errors [8][9][10], medication nonadherence [11], and drug-drug or drug-disease interactions [12]. Additionally, polypharmacy can also contribute to other geriatric syndromes such as falls, depression, and cognitive impairment [13].…”

Section: Introductionmentioning

confidence: 99%

Implementation considerations of deprescribing interventions: A scoping review

et al. 2023

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Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health‐care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health‐care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high‐risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health‐care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.

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The scope of drug-related problems in the home care setting

2018

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Introduction While drug-related problems (DRPs) in the inpatient setting are well known, the scope of these problems in home care has not been critically evaluated. Aim of the Review Our primary objective was to evaluate the incidence and demographics of DRPs in home care. Our specific aims were to characterize the rate of potentially inappropriate medications (PIMs), medication errors (MEs) and adverse drug events (ADEs) and to identify risk factors which contribute to DRPs in the home care setting. Methods Pubmed, Embase and CiNAHL databases were systematically searched from January 2000 to December 2016 for all publications which quantitatively characterized DRPs in the home care setting. Results The most commonly reported DRPs characterized in studies were PIMs (n = 16), MEs (n = 4) and the ME-subcategory medication-related discrepancies (n = 7). The frequency of PIMs ranged from 19.8 to 48.4%; up to 26% PIMs were considered severe. Polypharmacy (≥ 9 drugs) and increasing age were the most common risk factors for DRPs. Insufficient interdisciplinary teamwork and inconsistent performance of medication reviews were also risks factors for DRPs. Patients and/or caregivers were responsible for 42.3% of DRPs. Discussion Compared with acute inpatient care, DRPs are more frequently reported in home care. The rate of DRPs varies depending upon the reference used to define the problem. Conclusion Transfer of complete medical records and the use of an interdisciplinary team have the potential to reduce DRPs, including MEs, specifically when integrating a pharmacist providing regular medication review. Importantly, patients and informal caregivers must be significant partners with this interdisciplinary team.

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Drug Prescribing in the Elderly Receiving Home Care

Cited by 5 publications

References 29 publications

Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

Implementation considerations of deprescribing interventions: A scoping review

The scope of drug-related problems in the home care setting

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