General practitioners’ perspectives on discontinuation of long-term antidepressants in nursing homes

Leeuwen, Ellen Van; Anthierens, Sibyl; Driel, Mieke van; Sutter, An I. M. De; Branden, E. Van den; Christiaens, Thierry

doi:10.1080/13814788.2022.2038131

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Professional qualification as a barrier could be seen as an actual lack of qualifications but may also represent a lack of professional trust and knowledge about competencies between different health professionals. In line with previous research, insufficient time to make changes to the medication and a general view about not changing what is currently working were also found to be significant barriers to the deprescribing process [63,64]. Still, our development work showed that although some barriers persist to deprescribing of antidepressants, the GPs are more forthcoming in attempting to deprescribe antidepressants over antipsychotics, which have also been shown to be feasible in other studies [63,65,66].…”

Section: Discussionsupporting

confidence: 87%

“…In line with previous research, insufficient time to make changes to the medication and a general view about not changing what is currently working were also found to be significant barriers to the deprescribing process [63,64]. Still, our development work showed that although some barriers persist to deprescribing of antidepressants, the GPs are more forthcoming in attempting to deprescribe antidepressants over antipsychotics, which have also been shown to be feasible in other studies [63,65,66]. The reason for this is not fully elaborated in our study, but a hypothesis is, that the GPs are not as worried about withdrawal symptoms and that they generally do not believe there is an actual effect of the antidepressant medication.…”

Section: Discussionsupporting

confidence: 84%

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Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

Hølmkjær

Vermehren

Holm

et al. 2022

BMC Health Serv Res

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Introduction First-line treatment for behavioral and psychiatric symptoms of dementia is non-pharmacological. Still, psychotropic medication is widely used, despite its limited effect and harmful side-effects. More than half of all nursing home residents with dementia receive antidepressants, even though deprescribing is safe and feasible. Interventions to promote deprescribing of antidepressants in nursing homes are few and complex. To optimize the deprescribing process through an intervention, transparency for the development of the intervention is needed. We aim to describe the steps in the development and tailoring of an intervention targeting GPs, nursing home staff, and relatives to enhance collaboration on reducing the use of antidepressants in institutionalized older persons with dementia in Denmark. Method A step-wise process guided by the core elements in the Medical Research Council constituted the tailoring process. Five steps were included; 1) a literature search, 2) interviews with stakeholders, 3) drafting the intervention prototype, 4) professionals’ assessment of the intervention, and 5) refinement of the intervention. The steps were conducted from June 2020 to June 2022. Results Based on the literature search, interviews with stakeholders, and professionals’ assessment of the intervention, four main themes were identified; 1) focusing on antidepressants, 2) importance of professional qualifications, 3) collaboration and communication, and 4) patient and relative involvement. They guided intervention development and refinement of the final intervention, which included 1) a case-based training course and 2) a dialog tool including a symptom assessment scale to be used in a structured consultation at the nursing home. Conclusion This study presents a detailed account of the tailoring process for a complex intervention to optimize deprescribing of antidepressants for older persons with dementia at nursing homes. By presenting a thorough development process, we expect to achieve increased adherence to the intervention which is currently being tested in an ongoing cluster randomized controlled trial. The transparency of the process will also increase the future development of other similar complex interventions.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 84%

Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

Hølmkjær

Vermehren

Holm

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Provider-level factors associated with deprescribing include beliefs and/or attitudes about both prescribing (e.g., preventative medications, symptom management) and deprescribing (e.g., reluctance or fear of stopping medications) [73,[80][81][82][83][84]; clinical expertise, training, and experience with deprescribing [85]; knowledge about the patient, their preferences, and goals of care to inform deprescribing decisions [74,86]; and clinician time and resources to support collaboration among multiple providers to make deprescribing decisions [72]. Health-care system-level factors associated with deprescribing include clinical guidelines related to both prescribing and deprescribing practices, professional and provider culture about deprescribing [44], incomplete or inaccurate medication use information to inform deprescribing decisions, availability and feasibility of alternative treatments, reimbursement structure, and resources to support deprescribing and shared decision-making among multiple providers.…”

Section: Barriers and Enablers Of Deprescribingmentioning

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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Antidepressant deprescribing: State of the art and recommendations—A literature overview

Romagnoli,

Zovi,

Santoleri

et al. 2024

Eur J Clin Pharmacol

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General practitioners’ perspectives on discontinuation of long-term antidepressants in nursing homes

Cited by 4 publications

References 27 publications

Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

Implementation considerations of deprescribing interventions: A scoping review

Antidepressant deprescribing: State of the art and recommendations—A literature overview

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