The prescribing cascade game: Applying geriatric pharmacotherapy principles in the classroom

Testman, Julie A.

doi:10.1016/j.cptl.2014.05.001

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…In the United States, a study used Medicare data to explore the association between initiation of antipsychotics and use of antiparkinson agents. One study used sequence symmetry analysis—a statistical signal detection method—to identify prescribing cascades in administrative health data by examining concomitant drug use or drug prescribing sequences that reflected prescribing cascades.…”

Section: Resultsmentioning

confidence: 99%

“…Reversal of prescribing cascades is a shared effort between clinicians and patients to reverse a prescribing cascade after detection. We identified resources with important practical strategies to assist at all stages, including prescribing cascade detection algorithms, protocols, games, and checklists. Evaluations of these strategies found that their target groups received them favorably and showed efficacy in changing prescriber behavior by reducing medication burden in individuals.…”

Section: Discussionmentioning

confidence: 99%

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What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review

Brath

Mehta

Savage

et al. 2018

J American Geriatrics Society

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OBJECTIVES: To systematically describe the resources available on preventing, detecting, and reversing prescribing cascades using a scoping review methodology. MEASUREMENTS: We searched Medline, EMBASE, Psy-chINFO, CINAHL, Cochrane Library, and Sociological Abstracts from inception until July 2017. Other searches (Google Scholar, hand searches) and expert consultations were performed for resources examining how to prevent, detect, or reverse prescribing cascades. We used these three categories along the prescribing continuum as an organizing framework to categorize and synthesize resources. RESULTS: Of 369 resources identified, 58 met inclusion criteria; 29 of these were categorized as preventing, 20 as detecting, and 9 as reversing prescribing cascades. Resources originated from 14 countries and mostly focused on older adults. The goal of preventing resources was to educate and increase general awareness of the concept of prescribing cascades as a way to prevent inappropriate prescribing and to illustrate application of the concept to specific drugs (e.g., anticholinergics) and conditions (e.g., inflammatory bowel disease). Detecting resources included original investigations or case reports that identified prescribing cascades using health administrative data, patient cohorts, and novel sources such as social media. Reversing prescribing cascade resources focused on the medication review process and deprescribing initiatives. CONCLUSION:Prescribing cascades are a recognized problem internationally. By learning from the range of resources to prevent, detect, and reverse prescribing cascades, this review contributes to improving drug prescribing, especially in older adults.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review

Brath

Mehta

Savage

et al. 2018

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…Further, some have recommended developing alerts for electronic health records and pharmacy dispensing systems that identify particular medication combinations that may represent a cascade, an intervention which is likely to be welcomed by pharmacists [34,35]. At least one pharmacy school has taken steps to incorporate the concept and examples of prescribing cascades into its curriculum through a game-based recognition activity [36]. This approach could be explored further across the pharmacy, medicine and nursing curricula.…”

Section: Discussionmentioning

confidence: 99%

Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study

et al. 2020

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Background Prescribing cascades occur when the side effect of a medication is treated with a second medication. The aim of the study was to understand how prescribing cascades develop and persist and to identify strategies for their identification, prevention and management. Method This qualitative study employed semi-structured interviews to explore the existence of prescribing cascades and to gather patients', caregivers' and clinicians’ perspectives about how prescribing cascades start, persist and how they might be resolved. Participants were older adults (over age 65) at an outpatient Geriatric Day Hospital (GDH) with possible prescribing cascades (identified by a GDH team member), their caregivers, and healthcare providers. Data were analyzed using an inductive content analysis approach. Results Fourteen participants were interviewed (eight patients, one family caregiver, one GDH pharmacist, three GDH physicians and one family physician) providing a total of 22 interviews about patient-specific cases. The complexity and contextually situated nature of prescribing cascades created challenges for all of those involved with their identification. Three themes impacted how prescribing cascades developed and persisted: varying awareness of medications and cascades; varying feelings of accountability for making decisions about medication-related care; and accessibility to an ideal environment and relevant information. Actions to prevent, identify or resolve cascades were suggested. Conclusion Patients and healthcare providers struggled to recognize prescribing cascades and identify when they had occurred; knowledge gaps contributed to this challenge and led to inaction. Strategies that equip patients and clinicians with resources to recognize prescribing cascades and environmental and social supports that would help with their identification are needed. Current conceptualizations of cascades warrant additional refinement by considering the nuances our work raises regarding their appropriateness and directionality.

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“…15 At least one school of pharmacy, the University of Charleston School of Pharmacy, incorporates PC into its curricula. 16 'The Prescribing Cascade Game' introduces the concept, term, and examples of PC to student pharmacists…”

Section: Discussionmentioning

confidence: 99%

Drug-induced Adverse Events and Prescribing Cascades in Older Adults: Pharmacy Stakeholder Survey

Vouri

Reckenberg

2017

Innov Pharm

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Objectives:The aim of this study was to assess pharmacists' and student pharmacists ' understanding of drug-induced Keywords: drug-induced adverse events, education, prescribing cascade BACKGROUND Older adults are major consumers of prescription and nonprescription medications. Two-thirds of community-dwelling older adults (>65 years old) take five or more prescriptions, over-the-counter (OTC) products, and dietary supplements.

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The prescribing cascade game: Applying geriatric pharmacotherapy principles in the classroom

Cited by 9 publications

References 21 publications

What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review

What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review

Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study

Drug-induced Adverse Events and Prescribing Cascades in Older Adults: Pharmacy Stakeholder Survey

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