Practice pharmacists and the opportunity to support general practitioners in deprescribing in the older person

Peterson, Gregory M.; Naunton, Mark; Deeks, Louise S; Kosari, Sam; Jackson, Shane; Boom, Katja

doi:10.1002/jppr.1427

Cited by 11 publications

(22 citation statements)

References 12 publications

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“…Pharmacists are uniquely skilled to support deprescribing efforts in this setting. 21 We designed and pilot-tested workflow for a pharmacist-provided medication review during Medicare Annual Wellness Visits (AWVs), as this is a routinely scheduled and billable visit for the practice. 22…”

Section: Introductionmentioning

confidence: 99%

A pharmacist-led pilot program to facilitate deprescribing in a primary care clinic

LaValley¹,

Singh²,

Mustafa³

et al. 2020

Journal of the American Pharmacists Association

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Objective: To develop and pilot-test a model in which a community-based clinical pharmacist was incorporated as part of a Medicare Annual Wellness Visit (AWV) to make deprescribing recommendations targeted at potentially inappropriate medications (PIMs) in seniors. Setting: A family medicine patient-centered medical home (PCMH) clinic in Buffalo, NY. Practice description: Implementation and evaluation of a pilot program incorporating a pharmacist-provided medication review targeting PIMs in seniors as part of a Medicare AWV. Practice innovation: A community pharmacyebased clinical pharmacist provided face-to-face medication reviews for patients older than 65 years as part of their AWV with a focus on deprescribing PIMs. No clinical pharmacy service existed at the practice when this program was implemented. Evaluation: Identified PIMs, pharmacist recommendations, recommendation acceptance rate, time spent on intervention, health care utilization at 6 months postvisit, and barriers to implementation. Results: Of the 21 patients enrolled, 13 unique patients received a total of 20 deprescribing recommendations from the pharmacist. The overall acceptance rate for pharmacist recommendations was 20%. The pharmacist spent a mean (± SD) of 34 (± 6) minutes per patient encounter. One patient in the intervention group was hospitalized, and 1 was seen in the emergency department (ED) during the 6-month follow-up period compared with 1 patient in the control group who had an ED visit. We identified multiple logistical and organizational barriers to the implementation of the intervention. Conclusion: In this prospective pilot study, a workflow to include a pharmacist medication review to facilitate deprescribing in the primary care setting was tested. We encountered several barriers to integrating the pharmacist into the AWV workflow to deliver the intervention. Future pragmatic clinical trials are warranted to improve provider awareness and comfort with deprescribing PIMs in seniors.

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Section: Introductionmentioning

confidence: 99%

A pharmacist-led pilot program to facilitate deprescribing in a primary care clinic

LaValley¹,

Singh²,

Mustafa³

et al. 2020

Journal of the American Pharmacists Association

View full text Add to dashboard Cite

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“…Deprescribing is a complex task that includes clinical knowledge, shared decision making with patients and caregivers, and communication between all care providers [ 8 ]. Pharmacists are uniquely positioned and trained to regularly assess a patient’s medication regimen and identify older adults at risk for adverse drug events [ 9 ]. In the United States (US), the entry level degree to practice pharmacy is the Doctor of Pharmacy (PharmD) and, in addition to medicine distribution activities, pharmacists routinely practice in clinical positions, in which they work with medical providers to optimize medication therapies.…”

Section: Introductionmentioning

confidence: 99%

Knowledge and Attitudes of Student Pharmacists Regarding Polypharmacy and Deprescribing: A Cross-Sectional Study

et al. 2020

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Pharmacists play a key role in deprescribing medications. Incorporation of this concept into pharmacy school curricula is important in ensuring that graduates can address the complex needs of an aging population. The aims of this study were to assess if and how student pharmacists were exposed to deprescribing within their curriculum, to assess students’ perceptions regarding their attitudes, ability and confidence in deprescribing, and to assess if reported curricular exposure to this topic resulted in improved perceptions or objective knowledge assessment scores. An electronic survey was distributed to third- and fourth-year pharmacy students at 132 schools of pharmacy. The survey included three sections including: (i) demographics and questions on their exposure to deprescribing and other experiences within their curriculum; (ii) questions regarding their attitudes, ability, and confidence regarding deprescribing on a 5-point Likert-scale; (iii) a knowledge assessment on polypharmacy and deprescribing in the form of 12 multiple-choice questions. Likert-scale questions were analyzed as scales utilizing the mean score for items measuring student perceptions regarding deprescribing attitudes, ability, and confidence. Comparisons were made on each variable between students with and without curricular exposure to deprescribing using t-tests. Ninety-one responses were included in the analysis. Only 59.3% of respondents reported exposure to deprescribing in their didactic coursework. The mean scores on the polypharmacy and deprescribing knowledge assessments were 61.0% and 64.5%, respectively. Those with exposure to deprescribing concepts within their curriculum were more likely to agree that their school’s curriculum prepared them to deprescribe in clinical practice (t(89) = −2.26, p = 0.03). Pharmacy schools should evaluate their curricula and consider the addition of specific deprescribing objectives and outcome measures for didactic and experiential training.

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“…Physicians may not be well acquainted with the deprescribing process and its benefit due partly to the lack of adequate evidence to change the usual clinical practise 23 . Physicians’ decisions for deprescribing could be supported by other HCPs recommendations like pharmacists 37 . Thus, interprofessional communication could improve decision making and facilitate successful deprescribing practise because different HCPs may have different barriers and priorities for deprescribing interventions 29,38 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Aims Inappropriate polypharmacy poses risks of adverse drug events, high healthcare costs and mortality. Deprescribing could minimise inappropriate polypharmacy and the consequences thereof. The aim of this study was to evaluate healthcare providers’ (HCPs’) attitudes toward and experiences with deprescribing practice in Ethiopia. Methods We conducted an institution‐based cross‐sectional survey among HCPs at the University of Gondar Comprehensive Specialized Hospital, Ethiopia. We used a validated questionnaire developed by Linsky et al. The tool included questions that explore medication characteristics, current patient clinical factors, predictions of future health states, patients’ resources to manage their own health and education and experience. One‐way ANOVA was used to test the association between sociodemographic variables and their perception of deprescribing decisions. Results Of 85 HCPs approached, about 82 HCPs completed the survey, giving a response rate of 96.5%. Most of the participants (n = 73, 89%) have scored less than 1.5 points showing they are reluctant to proactively deprescribe. Physicians seem to be affected by the significant physical health conditions (mean = 1.68) and clinical endpoint like blood pressure (mean = 1.5) to make deprescribing decisions. According to the post hoc analysis of one‐way ANOVA, clinical pharmacists seemed to have a better attitude toward deprescribing decisions compared with physicians (P = .025). Conclusion HCPs’ decision to discontinue a medication could be multifactorial. Physicians could be influenced by physical health condition and clinical endpoints for deprescribing decision. Future studies should emphasise on barriers and facilitators to deprescribing practice specific to the context in Ethiopia.

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Practice pharmacists and the opportunity to support general practitioners in deprescribing in the older person

Cited by 11 publications

References 12 publications

A pharmacist-led pilot program to facilitate deprescribing in a primary care clinic

A pharmacist-led pilot program to facilitate deprescribing in a primary care clinic

Knowledge and Attitudes of Student Pharmacists Regarding Polypharmacy and Deprescribing: A Cross-Sectional Study

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

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