Impact of medication review, within a shared decision-making framework, on deprescribing in people living in care homes

Baqir, Wasim; Hughes, Julian C.; Jones, Tania; Barrett, Steven M.; Desai, Nisha; Copeland, Richard; Campbell, David; Laverty, Annie

doi:10.1136/ejhpharm-2016-000900

Cited by 33 publications

(28 citation statements)

References 23 publications

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“…Pending these guidelines, health professionals can rely on the safety evidence from a small but growing number of deprescribing studies. Indeed, the literature describes only a few cases of necessity for reintroduction of withdrawn or reduced medicines [33]. The evidence of the literature confirms that the clinical skills and knowledge engaged for prescribing and deprescribing are similar.…”

Section: Individual Level: Working On Pedagogy While Respecting Complmentioning

confidence: 90%

Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

et al. 2020

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Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents’ and relatives’ fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients’ health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient’s wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team.

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Section: Individual Level: Working On Pedagogy While Respecting Complmentioning

confidence: 90%

Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

et al. 2020

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“…Implementing shared decision-making between prescribers and patients ( Baqir et al, 2017 ; Bekker, 2018 ) and increasing patient awareness about medication waste ( Bekker et al, 2018b ; Bekker, 2018 ) may also help in minimising medication waste. A study has shown that shared decision-making between prescribers and patients and medicine optimisation reviews can lead to a reduction in polypharmacy and tailor medicines to a patient’s individual needs and thus reduce medication waste arising from unnecessary medications ( Baqir et al, 2017 ). Also, providing information on improving patients’ adherence to medicines and increasing awareness about medication waste that may occur due to non-adherence during consultation may help to tackle the problem.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the dispensing stage, transferring medications close to expiry to other pharmacies that are able to dispense them to patients in time may help in reducing medication waste ( Baqir et al, 2017 ; Bekker, 2018 ). Pharmacies could request medications that are needed and not in stock using an online database and can register medications close to expiratory date on the database.…”

Section: Discussionmentioning

confidence: 99%

“Don’t Let Medicines Go to Waste”—A Survey-Based Cross-Sectional Study of Pharmacists’ Waste-Reducing Activities Across Gulf Cooperation Council Countries

Alhomoud

2020

Front. Pharmacol.

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Objectives Medication waste has a negative environmental and economic impact. From avoiding unnecessary supply to recycling medicines that are no longer needed, pharmacists are placed in an advantageous position to minimise medication waste. Thus, the aim of this study was to detect waste-minimising activities undertaken by pharmacists to limit medication waste and to evaluate their importance for medication waste minimisation and feasibility for implementation. Methods A cross-sectional survey of 277 participants, conveniently selected from six Gulf countries. The eligibility criteria were pharmacists or pharmacy technicians, Arabic- or English-speaking individuals, aged ≥18 years, and living in the Gulf countries. An online self-administered survey was distributed during December 2019 and February 2020, via e-mail and social networks; it included the purpose of the study with a link to the webpage that hosted the questionnaire. Data were collected through the online survey site QuestionPro.com. All analyses were performed in SPSS Version 23 and Microsoft Excel. Results The majority of participants were female (175/277; 63%), hospital pharmacists (206/277; 74%), and had more than 10 years of work experience (100/277; 36%). This study indicates that most of the suggested activities (14/21) were implemented by the majority of pharmacists for minimising medication waste, except four activities in the dispensing stage and three activities in the leftover stage. Activities performed at the prescribing, dispensing and leftover stages were considered very important or important for reducing medication waste and very feasible or feasible for implementation in practice. Conclusions Many waste-minimising activities were undertaken by pharmacists in the prescribing, dispensing, and leftover stages. However, although waste-minimising activities were perceived as important for reducing waste and feasible for implementation in practice, not all activities were implemented in daily practice.

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“…For example, a case study of medication reviews in care homes involved meetings between residents, family members, care home staff, a pharmacist and (when possible) a GP. 191 Another example of an interprofessional approach to care planning (which involves SDM) comes from the Year of Care initiative when care planning involved a first consultation with a HCA who helped the patient work out 'what they want to do' followed by a second consultation with a GP or specialist nurse to make a care plan. 25 Both reported positive outcomes.…”

Section: Shared Decision-making and The New Models Of Carementioning

confidence: 99%

Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis

Bunn

Goodman

Russell

et al. 2018

Health Serv Deliv Res

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BackgroundHealth-care systems are increasingly moving towards more integrated approaches. Shared decision-making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; this is particularly the case for older people with complex needs.ObjectivesTo provide a context-relevant understanding of how models to facilitate SDM might work for older people with multiple health and care needs and how they might be applied to integrated care models.DesignRealist synthesis following Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards.ParticipantsTwenty-four stakeholders took part in interviews.Data sourcesElectronic databases including MEDLINE (via PubMed), The Cochrane Library, Scopus, Google and Google Scholar (Google Inc., Mountain View, CA, USA). Lateral searches were also carried out. All types of evidence were included.Review methodsIterative stakeholder-driven, three-stage approach, involving (1) scoping of the literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, (2) systematic searches for evidence to test and develop the theories and (3) validation of programme theory/ies with stakeholders (n = 11).ResultsWe included 88 papers, of which 29 focused on older people or people with complex needs. We identified four theories (context–mechanism–outcome configurations) that together provide an account of what needs to be in place for SDM to work for older people with complex needs: understanding and assessing patient and carer values and capacity to access and use care; organising systems to support and prioritise SDM; supporting and preparing patients and family carers to engage in SDM; and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that create trust between those involved, allow service users to feel that they are respected and understood, and engender confidence to engage in SDM.LimitationsThere is a lack of evidence on interventions to promote SDM in older people with complex needs or on interprofessional approaches to SDM.ConclusionsModels of SDM for older people with complex health and care needs should be conceptualised as a series of conversations that patients, and their family carers, may have with a variety of different health and care professionals. To embed SDM in practice requires a shift from a biomedical focus to a more person-centred ethos. Service providers are likely to need support, both in terms of the way services are organised and delivered and in terms of their own continuing professional development. Older people with complex needs may need support to engage in SDM. How this support is best provided needs further exploration, although face-to-face interactions and ongoing patient–professional relationships are key.Future workThere is a need for further work to establish how organisational structures can be better aligned to meet the requirements of older people with complex needs. This includes a need to define and evaluate the contribution that different members of health and care teams can make to SDM for older people with complex health and care needs.Study registrationThis study is registered as PROSPERO CRD42016039013.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Impact of medication review, within a shared decision-making framework, on deprescribing in people living in care homes

Cited by 33 publications

References 23 publications

Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study

“Don’t Let Medicines Go to Waste”—A Survey-Based Cross-Sectional Study of Pharmacists’ Waste-Reducing Activities Across Gulf Cooperation Council Countries

Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis

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