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Geremie T, Guiguet-Auclair C, Laroche ML, Mely P, Gerbaud L, Blanquet M. Deprescribing in older adults in a French community: a questionnaire study on patients' beliefs and attitudes. BMC Geriatr 2024; 24:562. [PMID: 38937665 PMCID: PMC11212408 DOI: 10.1186/s12877-024-05165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND General practitioners (GPs) have a central role to play on reduction of polypharmacy and deprescribing. This study aimed to assess beliefs and attitudes towards deprescribing in patients, aged 65 years or older in primary care, and to identify factors associated with deprescribing and their willingness to stop medication. METHODS A questionnaire study was performed between 23 May and 29 July 2022 on patients aged 65 years or older attending a GP's surgery in a French area. We used the French version of the revised Patients' Attitudes Towards Deprescribing self-report questionnaire (rPATD), which measures four subscales ("Burden", "Appropriateness", "Concerns about stopping" and, "Involvement"), patients' willingness to stop one of their regular medicines, and patients' satisfaction with their current medicines. RESULTS The study enrolled 200 patients. Median age was 76 years old (IQR 71-81), 55% were women, and 42.5% took 5 or more medications per day. Although most patients (92.5%) were satisfied with their current medicines, 35% were reluctant to stop medications they had been taking for a long time, and 89.5% were willing to stop medication if asked to by their GP. Patients aged less than 75 years old reported more concerns about stopping. Women and patients with higher educational attainment showed significantly higher involvement in medication management. CONCLUSIONS The majority of older adults were willing to stop one or more of their regular medicines if asked to do so by their GP. GPs should address deprescribing into their current practice.
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Affiliation(s)
| | - Candy Guiguet-Auclair
- Public Health, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Auvergne INP, Clermont Auvergne College, University Hospital of Clermont-Ferrand, CNRS Pascal Institute, Clermont-Ferrand, France
| | - Marie Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology- Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France
- UR 24134 (Ageing, Frailty, Prevention, e-Health), Institute Omega Health, University of Limoges, Limoges, France
| | - Pierre Mely
- Surgery of Riom-ès-Montagnes, Riom-ès-Montagnes, France
| | - Laurent Gerbaud
- Public Health, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Auvergne INP, Clermont Auvergne College, University Hospital of Clermont-Ferrand, CNRS Pascal Institute, Clermont-Ferrand, France
| | - Marie Blanquet
- Public Health, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
- Clermont Auvergne INP, Clermont Auvergne College, University Hospital of Clermont-Ferrand, CNRS Pascal Institute, Clermont-Ferrand, France.
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Japelj N, Horvat N, Knez L, Kos M. Deprescribing: An umbrella review. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2024; 74:249-267. [PMID: 38815201 DOI: 10.2478/acph-2024-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 06/01/2024]
Abstract
This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where depre-scribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta--analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with deprescribing intervention trials (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with medication cessation trials (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with deprescribing intervention trials. Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of medication cessation trials, a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications.
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Affiliation(s)
- Nuša Japelj
- 1University of Ljubljana Faculty of Pharmacy, Department of Social Pharmacy 1000 Ljubljana, Slovenia
| | - Nejc Horvat
- 1University of Ljubljana Faculty of Pharmacy, Department of Social Pharmacy 1000 Ljubljana, Slovenia
| | - Lea Knez
- 1University of Ljubljana Faculty of Pharmacy, Department of Social Pharmacy 1000 Ljubljana, Slovenia
- 2University Clinic Golnik 4204 Golnik, Slovenia
| | - Mitja Kos
- 1University of Ljubljana Faculty of Pharmacy, Department of Social Pharmacy 1000 Ljubljana, Slovenia
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Hung A, Kim YH, Pavon JM. Deprescribing in older adults with polypharmacy. BMJ 2024; 385:e074892. [PMID: 38719530 DOI: 10.1136/bmj-2023-074892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Polypharmacy is common in older adults and is associated with adverse drug events, cognitive and functional impairment, increased healthcare costs, and increased risk of frailty, falls, hospitalizations, and mortality. Many barriers exist to deprescribing, but increased efforts have been made to develop and implement deprescribing interventions that overcome them. This narrative review describes intervention components and summarizes findings from published randomized controlled trials that have tested deprescribing interventions in older adults with polypharmacy, as well as reports on ongoing trials, guidelines, and resources that can be used to facilitate deprescribing. Most interventions were medication reviews in primary care settings, and many contained components such as shared decision making and/or a focus on patient care priorities, training for healthcare professionals, patient facing education materials, and involvement of family members, representing great heterogeneity in interventions addressing polypharmacy in older adults. Just over half of study interventions were found to perform better than usual care in at least one of their primary outcomes, and most study interventions were assessed over 12 months or less.
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Affiliation(s)
- Anna Hung
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Co-first authors
| | - Yoon Hie Kim
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Co-first authors
| | - Juliessa M Pavon
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Geriatrics Research, Education, and Clinical Center (GRECC) Durham VA Health Care System, Durham, NC, USA
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Koren MJ, Kelly NA, Lau JD, Jonas CK, Pinheiro LC, Banerjee S, Safford MM, Goyal P. Association of Healthy Lifestyle and Incident Polypharmacy. Am J Med 2024; 137:433-441.e2. [PMID: 38176533 PMCID: PMC11058024 DOI: 10.1016/j.amjmed.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Polypharmacy, commonly defined as taking ≥5 medications, is an undesirable state associated with lower quality of life. Strategies to prevent polypharmacy may be an important priority for patients. We sought to examine the association of healthy lifestyle, a modifiable risk factor, with incident polypharmacy. METHODS We performed a secondary analysis of the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study, including 15,478 adults aged ≥45 years without polypharmacy at baseline. The primary exposure was healthy lifestyle at baseline as measured by the Healthy Behavior Score (HBS), a cumulative assessment of diet, exercise frequency, tobacco smoking, and sedentary time. HBS ranges from 0-8, whereby 0-2 indicates low HBS, 3-5 indicates moderate HBS, and 6-8 indicates high HBS. We used multinomial logistic regression to examine the association between HBS and incident polypharmacy, survival without polypharmacy, and death. RESULTS Higher HBS (i.e., healthier lifestyle) was inversely associated with incident polypharmacy after adjusting for sociodemographic and baseline health variables. Compared with participants with low HBS, those with moderate HBS had lower odds of incident polypharmacy (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.73-0.98) and lower odds of dying (OR 0.74; 95% CI, 0.65-0.83). Participants with high HBS had even lower odds of both incident polypharmacy (OR 0.75; 95% CI, 0.64-0.88) and death (OR 0.62; 95% CI, 0.54-0.70). There was an interaction for age, where the association between HBS and incident polypharmacy was most pronounced for participants aged ≤65 years. CONCLUSIONS Healthier lifestyle was associated with lower risk for incident polypharmacy.
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Affiliation(s)
- Melanie J Koren
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Jennifer D Lau
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Chanel K Jonas
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Samprit Banerjee
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | | | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY.
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Wang J, Shen JY, Conwell Y, Podsiadly EJ, Caprio TV, Nathan K, Yu F, Ramsdale EE, Fick DM, Mixon AS, Simmons SF. Implementation considerations of deprescribing interventions: A scoping review. J Intern Med 2024; 295:436-507. [PMID: 36524602 DOI: 10.1111/joim.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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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Affiliation(s)
- Jinjiao Wang
- Elaine, Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J Podsiadly
- Harriet J. Kitzman Center for Research Support, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Home Care, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Center, Finger Lakes Geriatric Education Center, Rochester, New York, USA
| | - Kobi Nathan
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Erika E Ramsdale
- Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Amanda S Mixon
- Department of Medicine, Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Carver J, Springer SP. Patient Attitudes Toward Deprescribing Among Community-Dwelling Older Mainers. Sr Care Pharm 2024; 39:30-41. [PMID: 38160235 DOI: 10.4140/tcp.n.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background The excess use of medications has become an increasingly prevalent issue in health care. Deprescribing can be an important tool in combating polypharmacy. Objective To assess the attitudes of community-dwelling older persons in Maine toward their medications and the concept of deprescription. An additional aim of this research was to assess the association between the revised Patient Attitudes Toward Deprescribing Questionnaire (rPATDQ) domains by polypharmacy status. Methods Researchers conducted a cross-sectional study utilizing the rPATDQ. Authors recruited older Mainers via a longitudinal cohort study through the University of New England Center for Excellence in Aging in Health. Respondents were stratified by polypharmacy status (fewer than five medications, five or more medications). Results Total daily medications ranged from 1 to 30 (average of 8.6). Overall, 83.6% of respondents agreed/strongly agreed to the statement "If my doctor said it was possible, I would be willing to stop one or more of my regular medicines." 70.6% agreed/ strongly agreed to the statement "Overall, I am satisfied with my current medicines." Those with and without polypharmacy experienced low overall medication burden and a high belief in the appropriateness of their medications. There were no statistically significant differences between polypharmacy groups. Conclusion The results of this survey indicate that the factors affecting attitudes toward deprescribing are complex. While many indicated willingness to deprescribe at least one medication, there was a high degree of satisfaction with current medication regimens. This study highlights the need for further qualitative research to identify potential barriers to deprescribing.
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Affiliation(s)
- Joshua Carver
- University of New England School of Pharmacy, Portland, Maine
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Zhou D, Chen Z, Tian F. Deprescribing Interventions for Older Patients: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:1718-1725. [PMID: 37582482 DOI: 10.1016/j.jamda.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Deprescribing reduces polypharmacy in older adults. A thorough study of the effect of deprescribing interventions on clinical outcomes in older adults is presently lacking. As a result, we evaluated the impact of deprescribing on clinical outcomes in older patients. DESIGN Meta-analysis and systematic review of randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane Library were searched from the time of creation to March 2023. SETTING AND PARTICIPANTS Randomized controlled trial with participants at least 60 years old. MEASURES Mortality, falls (number of fallers), hospitalization rates, emergency department visits, medication adherence, HRQoL (health-regulated quality of life), incidence of ADR (adverse drug reactions), PIM (potentially inappropriate medication), and PPO (potentially prescription omission) were evaluated in the meta-analysis. RESULTS A total of 32 RCTs (18,670 patients) were included. Deprescribing interventions significantly reduced proportions of older adults with PIM, PPO, and the incidence of ADRs. The interventions group also improved medication compliance. CONCLUSIONS AND IMPLICATIONS Compared to routine care, deprescribing interventions significantly improve clinical outcome indicators for older adults.
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Affiliation(s)
- Dan Zhou
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China; Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Chang CT, Teoh SL, Cheah WK, Lee PJ, Azman MA, Ling SH, Chuah ASC, Sabki NH, George D, Oh HL, Goh JY, Lee SH, Foong WK, Lee JCY, Chan HK, Teoh LR, Lim XJ, Rajan P, Lee SWH. Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol. J Pharm Policy Pract 2023; 16:113. [PMID: 37789376 PMCID: PMC10546756 DOI: 10.1186/s40545-023-00621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Polypharmacy and the use of potentially inappropriate medications (PIMs) are prevalent among older patients admitted to hospitals, posing a heightened risk of adverse drug events. This trial aims to evaluate the effectiveness of a pharmacist-led deprescribing intervention in reducing medications, PIM and improving clinical outcomes, using the locally developed Malaysian Potentially Inappropriate Prescribing Screening tool in Older Adults (MALPIP). METHODS This is an 18-month cluster-randomized, open-label, parallel-arm controlled trial conducted at 14 public hospitals in the Perak state of Malaysia. Patients aged 60 and above, who have at least one medication and one comorbidity are eligible. A stratified-cluster randomization design is employed, with 7 hospitals assigned to the control arm and 7 hospitals assigned to the intervention arm. The MALPIP screening tool will be used in the intervention group to review the medications. If PIM is detected, the pharmacists will discuss with doctors and decide whether to stop or reduce the dose. The primary outcomes of this trial are the total number of medications and number of PIM. The secondary outcomes include fall, emergency department visits, readmissions, quality of life and mortality. Outcomes will be measured during enrolment, discharge, 6, 12, and 18 months. DISCUSSION This REVMED trial aims to test the hypothesis that a pharmacist-led deprescribing intervention initiated in the hospital will reduce the total number of medications and PIM 18 months after hospital discharge, reducing fall, emergency department visits, readmissions, mortality and lead to improvement in quality of life. Trial findings will quantify the clinical outcomes associated with reducing medications and PIM for hospitalized older adults with polypharmacy. TRIAL REGISTRATION NUMBER This trial was prospectively registered at clinicaltrials.gov (NCT05875623) on the 25th of May 2023. NCT05875623 Clinicaltrials.gov URL: NCT05875623 registered on 25th July 2023.
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Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia.
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia.
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Wee Kooi Cheah
- Clinical Research Centre, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
- Department of Medicine, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Pei Jia Lee
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Muhammad Azuan Azman
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Shiau Hui Ling
- Pharmacy Department, Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Malaysia
| | - Angie Su Ching Chuah
- Pharmacy Department, Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Malaysia
| | - Noor Hamizah Sabki
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Doris George
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Hoey Lin Oh
- Pharmacy Department, Hospital Slim River, Ministry of Health Malaysia, Slim River, Malaysia
| | - Jing Yi Goh
- Pharmacy Department, Hospital Slim River, Ministry of Health Malaysia, Slim River, Malaysia
| | - Siew Huang Lee
- Pharmacy Department, Hospital Kuala Kangsar, Ministry of Health Malaysia, Kuala Kangsar, Malaysia
| | - Wai Keng Foong
- Pharmacy Department, Hospital Batu Gajah, Ministry of Health Malaysia, Batu Gajah, Malaysia
| | - Jason Choong Yin Lee
- Perak Pharmaceutical Services Division, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
| | - Huan Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Lee Rhui Teoh
- Pharmacy Department, Hospital Sungai Siput, Ministry of Health Malaysia, Sungai Siput, Malaysia
| | - Xin Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
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Gadisa DA, Gebremariam ET, Yimer G, Deresa Urgesa E. Attitudes of Older Adult Patients and Caregivers Towards Deprescribing of Medications in Ethiopia. Clin Interv Aging 2023; 18:1129-1143. [PMID: 37522072 PMCID: PMC10378541 DOI: 10.2147/cia.s400698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/17/2023] [Indexed: 08/01/2023] Open
Abstract
Background Deprescribing is essential for reducing inappropriate medication use and polypharmacy. For a holistic approach, it is essential to know how older adult patients and their caregivers perceive deprescribing. Objective To assess the attitude of older adult patients and caregivers towards deprescribing medication at Ambo University Referral Hospital. Methodology Institutional-based cross-sectional study was conducted using the revised Patients' Attitude Towards Deprescribing tool (rPATD). The data was analyzed using the SPSS-25 software. Backward linear regression and logistic regression were used to measure association between outcome and determinant variables. The two-sided P-value ≤0.05 with 95% confidence interval was utilized for reporting significant factors. Results One hundred fifty-six (81.3%) of the respondents (ie, 85.0% of older adult and 77.2% of caregivers) agreed to stop one or more of their regular medications if the physician said it was possible despite 98 (51.0%) of them (ie, 49.0% of older adult and 53.3% of caregivers) being satisfied with their/their care recipient's medications. On the overall aggregate mean score, the respondents had a neutral position (2.6-3.59) regarding the burden and concerns of stopping medications whereas the majority of them disagree (1.0-2.59) with the inappropriateness of the medication they were taking and agreed (3.6-5.0) with the need for their involvement in treatment decision making. Concerns about stopping medicine scores (AOR = 0.440, 95% CI = 0.262-0.741, P = 0.035) and perceived levels of medication inappropriateness (AOR = 0.653, 95% CI = 0.456-0.936, P = 0.020) was significantly associated with the willingness to discontinue and overall satisfaction with their medicine regimen respectively. Conclusion The majority of older adult patients and caregivers would like to deprescribe if the physicians recommended it. The perceived concerns of stopping and inappropriateness of the medicines were associated with the willingness to deprescribe and overall satisfaction with their medicine respectively. Healthcare providers should prompt the deprescribing process with older adult patients and caregivers by addressing their concerns about stopping medications.
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Affiliation(s)
- Diriba Alemayehu Gadisa
- Pharmacy Department, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia, Ethiopia
| | | | - Getnet Yimer
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Global Genomics & Health Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Efa Deresa Urgesa
- Contract Director Management Department, Ethiopian Pharmaceutical Supply Service, Addis Ababa, Ethiopia
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Laprise C. It's time to take a sustainable approach to health care in the face of the challenges of the 21st century. One Health 2023; 16:100510. [PMID: 36844975 PMCID: PMC9939387 DOI: 10.1016/j.onehlt.2023.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Health challenges in the 21st century have become increasingly complex and global. The recent COVID-19 pandemic has only exacerbated the many problems faced by health care systems around the world and sadly, exposed various flaws. With ageing populations, particularly in Canada, as well as unavoidable factors such as globalization and accelerating climate change, it is becoming imperative to implement a new health care approach based on intersectorality and interdisciplinarity. Furthermore, links must be forged between all the stakeholders, i.e. the researchers, the health system and its specialists, the communities and the individuals themselves. It is in this perspective, where everyone concerned must be equally involved in attaining a better quality of life, that the concepts of One Health and sustainable health must be deployed.
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Affiliation(s)
- Catherine Laprise
- Centre Intersectoriel en Santé Durable, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada,Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, QC G7H 2B1, Canada,Centre Intégré Universitaire en Santé et Services Sociaux du Saguenay–Lac-Saint-Jean, Saguenay, QC G7H 7K9, Canada,Corresponding author at : Département des Sciences Fondamentales, Université du Québec à Chicoutimi, Saguenay, Québec G7H 2B1, Canada
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Kim JL, Lewallen KM, Hollingsworth EK, Shah AS, Simmons SF, Vasilevskis EE. Patient-Reported Barriers and Enablers to Deprescribing Recommendations During a Clinical Trial (Shed-MEDS). THE GERONTOLOGIST 2023; 63:523-533. [PMID: 35881109 PMCID: PMC10028229 DOI: 10.1093/geront/gnac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Effective deprescribing requires shared decision making between a patient and their clinician, and should be used when implementing evidence-based deprescribing conversations. As part of the Shed-MEDS clinical trial, this study assessed barriers and enablers that influence patient decision making in deprescribing to inform future implementation efforts and adaptations. RESEARCH DESIGN AND METHODS Shed-MEDS, a randomized controlled deprescribing trial, included hospitalized older adults discharging to post-acute care facilities. A trained clinician reviewed each participant's medical history and medication list to identify medications with potential for deprescribing. The study clinician then conducted a semistructured patient-centered deprescribing interview to determine patient (or surrogate) concerns about medications and willingness to deprescribe. Reeve et al.'s (2013) framework was used to categorize barriers and enablers to deprescribing from the patient's perspective, including "appropriateness of cessation," "fear," "dislike of a medication," "influences," and "process of cessation." RESULTS Overall, participants/surrogates (N = 177) agreed with 63% (883 total medications) of the study clinician's deprescribing recommendations. Thematic analysis revealed that "appropriateness" of a medication was the most common barrier (88.2%) and enabler (67.3%) to deprescribing. Other deprescribing enablers were in the following domains: "influences" (22.7%), "process" (22.5%), "pragmatic" (19.4%), and "dislike" (5.3%). DISCUSSION AND IMPLICATIONS Use of a semistructured deprescribing interview conversation tool allowed study clinicians to elicit individual barriers and enablers to deprescribing from the patient's perspective. Participants in this study expressed more agreement than disagreement with study clinicians' deprescribing recommendations. These results should inform future implementation efforts that incorporate a patient-centered framework during deprescribing conversations. CLINICAL TRIALS REGISTRATION NUMBER NCT02979353.
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Affiliation(s)
- Jennifer L Kim
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Kanah M Lewallen
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Emily K Hollingsworth
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Avantika S Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, & Clinical Center (GRECC), VA Tennessee Healthcare System, Nashville, Tennessee, USA
| | - Eduard E Vasilevskis
- Geriatric Research, Education, & Clinical Center (GRECC), VA Tennessee Healthcare System, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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Smith NI, Martinez AI, Huffmyer M, Eckmann L, George R, Abner EL, Jicha GA, Moga DC. Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study. BMC Geriatr 2023; 23:137. [PMID: 36894900 PMCID: PMC9999619 DOI: 10.1186/s12877-023-03876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer's Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medication-induced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD. METHODS Community dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations. RESULTS Among the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications. CONCLUSION The evaluation of modifications to MTM recommendations demonstrated that pharmacists' initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations. TRIAL REGISTRATION Study registration number: clinicaltrial.gov NCT02849639 registered on 29/07/2016.
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Affiliation(s)
- Noah I. Smith
- University of Kentucky College of Pharmacy, Lexington, KY USA
| | - Ashley I. Martinez
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA USA
| | - Mark Huffmyer
- University of Kentucky College of Pharmacy, Lexington, KY USA
- University of Kentucky Healthcare, Lexington, KY USA
- LLC Consulting Services, Lexington, KY PRO2RX USA
| | | | - Rosmy George
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
| | - Erin L. Abner
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Public Health, Lexington, KY USA
| | - Gregory A. Jicha
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Medicine, 789 S Limestone, Lexington, KY 40536 USA
| | - Daniela C. Moga
- University of Kentucky College of Pharmacy, Lexington, KY USA
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Public Health, Lexington, KY USA
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13
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Oktora MP, Yuniar CT, Amalia L, Abdulah R, Hak E, Denig P. Attitudes towards deprescribing and patient-related factors associated with willingness to stop medication among older patients with type 2 diabetes (T2D) in Indonesia: a cross-sectional survey study. BMC Geriatr 2023; 23:21. [PMID: 36635653 PMCID: PMC9835373 DOI: 10.1186/s12877-022-03718-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people with type 2 diabetes (T2D). It seems that many patients in low-middle-income countries are not willing to have their medicines deprescribed. This study aims to assess attitudes of Indonesian patients with T2D towards deprescribing in general and regarding specific cardiometabolic medicines, and factors influencing their willingness to stop medicines. METHODS Primary care patients with T2D of ≥60 years in Indonesia completed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Attitudes in general and for cardiometabolic medicines were reported descriptively. Proportions of patients willing to stop one or more medicines when recommended by different healthcare professionals were compared with Chi-square test. Multiple regression analysis was used to analyse the influence between patient-related factors and the willingness to stop medicines. RESULTS The survey was completed by 196 participants (median age 69 years, 73% female). The percentages willing to stop medicines were 69, 67, and 41%, when the general practitioner (GP), the specialist, or the pharmacist initiates the process (p-value < 0.001). Higher perceived burden of medicines (p-value = 0.03) and less concerns about stopping (p-value < 0.001) were associated with a higher willingness to stop medicines if proposed by the GP. Patients using multiple glucose-regulating medicines were less willing to stop (p-value = 0.02). Using complementary or alternative medicines was not associated with the willingness to stop. If proposed by their pharmacist, patients without substantial education were more willing to stop than educated patients. CONCLUSIONS Only two-thirds of older people with T2D in Indonesia were willing to stop one or more of their medicines if the GP or specialist recommended this, and even less when the pharmacist proposed this. Attention should be given to concerns about stopping specific medicines, especially among patients using multiple glucose-lowering medicines, who may be more eligible but were less willing to accept deprescribing.
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Affiliation(s)
- Monika Pury Oktora
- grid.4830.f0000 0004 0407 1981University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Cindra Tri Yuniar
- grid.434933.a0000 0004 1808 0563School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Institut Teknologi Bandung (ITB), Bandung, Indonesia
| | - Lia Amalia
- grid.434933.a0000 0004 1808 0563School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Institut Teknologi Bandung (ITB), Bandung, Indonesia
| | - Rizky Abdulah
- grid.11553.330000 0004 1796 1481Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran (UNPAD), Bandung, Indonesia
| | - Eelko Hak
- grid.4830.f0000 0004 0407 1981Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and –Economics, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- grid.4830.f0000 0004 0407 1981University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
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14
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Chang CT, Mohd Shariff SM, Abu Bakar NS, Ramzuzzaman NS, Lim CK, Lim EYJ, Ong PS, Lee JM, Tan AY, Kamis SF, Liew WM, Low YM, George D, Voo JYH, Tan HS, Rajan P, Lee SWH. Polypharmacy and potentially inappropriate medications among hospitalized older adults with COVID-19 in Malaysian tertiary hospitals. J Pharm Policy Pract 2023; 16:2. [PMID: 36635766 PMCID: PMC9836327 DOI: 10.1186/s40545-022-00504-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Older adults are among the most vulnerable groups during the COVID-19 epidemic, contributing to a large proportion of COVID-19-related death. Medication review and reconciliation by pharmacist can help reduce the number of potentially inappropriate medications but these services were halted during COVID-19. AIM To assess the prevalence and factors associated with inappropriate medicine use among older populations with COVID-19. METHODS This was a cross-sectional, retrospective analysis of medications among hospitalized older adults with COVID-19. Potentially inappropriate medication use was categorized using the Beer's and STOPP criteria. RESULTS Combining both criteria, 181 (32.7%) of the 553 patients were identified to have used at least one or more potentially inappropriate medication. A marginally higher number of inappropriate medications was documented using the Beers 2019 criteria (151 PIM in 124 patients) compared to STOPP criteria (133 PIMS in 104 patients). The long-term use of proton pump inhibitors (n = 68; 12.3%) and drugs which increases the risk of postural hypotension were the most commonly reported PIM (n = 41; 7.4%). Potentially inappropriate medication use was associated with previous history of hospital admission in the past 12 months (Odds ratio [OR]: 2.27; 95% CI 1.29-3.99) and higher number of discharge medications. CONCLUSIONS Nearly, one in three older adults with COVID-19 had been prescribed a PIM, and the proportion of older adults with polypharmacy increased after discharge. This highlights the importance of having clinical pharmacist conducting medication reviews to identify PIMs and ensure medication appropriateness.
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Affiliation(s)
- Chee-Tao Chang
- Clinical Research Centre (CRC) HRPB Ipoh, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia ,grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Nur Suriana Abu Bakar
- Pharmacy Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Malaysia
| | | | - Chun Kiat Lim
- Pharmacy Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Malaysia
| | - Eddy Yew Joe Lim
- Pharmacy Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Malaysia
| | - Peng Seng Ong
- grid.477137.10000 0004 0573 7693Pharmacy Department, Hospital Pulau Pinang, Ministry of Health Malaysia, George Town, Malaysia
| | - Jie Min Lee
- grid.477137.10000 0004 0573 7693Pharmacy Department, Hospital Pulau Pinang, Ministry of Health Malaysia, George Town, Malaysia
| | - Aie Yen Tan
- Pharmacy Department, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Siti Fatimah Kamis
- Pharmacy Department, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Wei Mun Liew
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Yuet Man Low
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Doris George
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - James Yau Hon Voo
- Pharmacy Department, Hospital Duchess of Kent, Ministry of Health Malaysia, Sandakan, Malaysia
| | - Hoo Seng Tan
- Pharmacy Department, Hospital Duchess of Kent, Ministry of Health Malaysia, Sandakan, Malaysia
| | - Philip Rajan
- Clinical Research Centre (CRC) HRPB Ipoh, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia ,grid.452879.50000 0004 0647 0003School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
| | - Shaun Wen Huey Lee
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
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15
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Gray SL, Fornaro R, Turner J, Boudreau DM, Wellman R, Tannenbaum C, Marcum ZA, Balderson B, Cook A, Jacobsen AL, Phelan EA. Provider knowledge, beliefs, and self‐efficacy to deprescribe opioids and sedative‐hypnotics. J Am Geriatr Soc 2022; 71:1580-1586. [PMID: 36546768 DOI: 10.1111/jgs.18202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND While many studies have assessed and measured patient attitudes toward deprescribing, less quantitative research has addressed the provider perspective. We thus sought to describe provider knowledge, beliefs, and self-efficacy to deprescribe, with a focus on opioids and sedative-hypnotics. METHODS An electronic anonymous survey was distributed to primary care providers at Kaiser Permanente Washington. Two reminder emails were sent. The survey included 10 questions on general deprescribing, and six questions each specific to opioid and sedative-hypnotic deprescribing. Knowledge questions used a multiple-choice response option format. Questions addressing beliefs and self-efficacy (i.e., confidence) used a 0-10 Likert scale. Scales were dichotomized at ≥7 to define agreement (belief questions) or confidence (self-efficacy questions). We calculated descriptive statistics to summarize the responses. RESULTS Of 370 eligible primary care providers, 95 (26%) completed the survey. For general deprescribing questions, a majority believed that lack of patient willingness, withdrawal symptoms and fear of symptom return, and time constraints impeded deprescribing. Approximately half chose the correct answers about opioid deprescribing, 21% were confident that they could alleviate patient concerns about opioid tapering, and 32% were confident managing chronic non-cancer pain without opioids. For sedative-hypnotics, 64%-87% of respondents correctly answered questions about risks and the relative effectiveness of alternatives, but only one-third correctly answered a question about sedative-hypnotic tapering. Roughly half were confident in their ability to successfully engage patients in sedative deprescribing conversations and select alternatives. Only 54% and 34% were confident in writing a tapering protocol for opioids and sedative-hypnotics, respectively. CONCLUSION Results suggest that raising provider awareness of patient willingness to deprescribe, addressing knowledge gaps, and increasing self-efficacy for deprescribing are important targets for improving deprescribing. Support for writing tapering protocols and prescribing evidence-based drug and non-drug alternatives may be important to improve care.
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Affiliation(s)
- Shelly L. Gray
- Department of Pharmacy, School of Pharmacy University of Washington Seattle Washington USA
| | - Rachyl Fornaro
- Department of Pharmacy UW Medicine Valley Medical Center Renton Washington USA
| | - Justin Turner
- Centre de Recherche, Institut universitaire de gériatrie de Montréal, Montréal, Québec Faculté de pharmacie Université de Montréal Montréal Canada
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Denise M. Boudreau
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington Seattle Washington USA
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington Seattle Washington USA
| | - Cara Tannenbaum
- Centre de Recherche, Institut universitaire de gériatrie de Montréal, Montréal, Québec Faculté de pharmacie Université de Montréal Montréal Canada
| | - Zachary A. Marcum
- Department of Pharmacy, School of Pharmacy University of Washington Seattle Washington USA
| | - Benjamin Balderson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington Seattle Washington USA
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington Seattle Washington USA
| | | | - Elizabeth A. Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, and Department of Health Systems and Population Health, School of Public Health University of Washington Seattle Washington USA
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16
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Lee HG, Kwon S, Jang BH, Jeon JP, Lee YS, Jung WS, Moon SK, Cho KH. A Study on the Perceptions of Korean Older Adult Patients and Caregivers about Polypharmacy and Deprescribing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11446. [PMID: 36141719 PMCID: PMC9517474 DOI: 10.3390/ijerph191811446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Polypharmacy is continuously increasing among older adults. The resultant potentially inappropriate medications (PIMs) can be harmful to patient health. Deprescribing refers to stopping or reducing PIMs. In this study, the current status of polypharmacy and willingness of older adults to deprescribe were investigated among patients and caregivers who are not associated with one another. The survey used the Korean translated version of the revised Patients' Attitude Towards Deprescribing (rPATD) Scale. Data were collected through an online survey of 500 participants (250 patients and caregivers each) in this study. The following results were found for patients and caregivers, respectively: 74.8% and 63.6% felt their number of medications was high, 64.4% and 55.6% desired to reduce their medications, 70.4% and 60.8% were concerned about medication discontinuation, 63.2% and 61.2% had a good understanding of their medications, 77.6% and 76.4% were willing to be well informed, and 79.6% and 72% wanted to reduce the number of medications if medically feasible. Patients and caregivers commonly agreed to the burden of the number of medications they were taking, and were willing to reduce the number of medications if the doctor said it was possible. Doctors should consider this information during the deprescribing process, and promote deprescription while involving patients and caregivers in the decision-making process.
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Affiliation(s)
- Han-Gyul Lee
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Seungwon Kwon
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Korea
| | - Woo-Sang Jung
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Sang-Kwan Moon
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Ki-Ho Cho
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
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17
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Roux B, Rakheja B, Sirois C, Niquille A, Pétein C, Ouellet N, Spinewine A, Sibille FX, Laroche ML. Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study. Eur J Clin Pharmacol 2022; 78:1633-1646. [PMID: 35896803 DOI: 10.1007/s00228-022-03368-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Successful deprescribing requires understanding the attitudes of older adults and caregivers towards this process. This study aimed to capture these attitudes in four French-speaking countries and to investigate associated factors. METHODS A multicenter cross-sectional study was conducted by administrating the French version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Belgium, Canada, France, and Switzerland. Community-dwelling or nursing home older adults ≥ 65 years taking ≥ 1 prescribed medications and caregivers of older adults with similar characteristics were included. Multivariate logistic regressions were carried out to examine factors associated with willingness to deprescribe. RESULTS A total of 367 older adults (79.3 ± 8.7 years, 63% community-dwelling, 54% ≥ 5 medications) and 255 unrelated caregivers (64.4 ± 12.6 years) of care recipients (83.4 ± 7.9 years, 52% community-dwelling, 69% ≥ 5 medications) answered the questionnaire. Among them, 87.5% older adults and 75.6% caregivers would be willing to stop medications if the physician said it was possible. Reluctance to stop a medication taken for a long time was expressed by 46% of both older adults and caregivers. A low score for the factor "concerns about stopping" (older adults: aOR: 0.21; 95% CI: 0.07-0.59), and a high score for the factor "involvement" (older adults: aOR: 2.66; 95% CI: 1.01-7.07; caregivers: aOR: 11.28; 95% CI: 1.48-85.91) were associated with willingness to deprescribe. CONCLUSIONS A significant proportion of older adults and caregivers of French-speaking countries are open to deprescribing. Despite this apparent willingness, deprescribing conversations in clinical practice remains marginal, emphasizing the importance of optimizing the integration of existing tools such as rPATD.
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Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | | | - Caroline Sirois
- Faculty of Pharmacy, Laval University, Quebec, Canada.,Centre of Excellence On Aging of Quebec, Quebec, Canada.,Centre de recherche sur les soins et les Services de premieres lignes de l'Université Laval, Quebec, Canada
| | - Anne Niquille
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Community Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - Nicole Ouellet
- Department of Health, University of Quebec at Rimouski, Rimouski, Canada
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Yvoir, Belgium
| | - François-Xavier Sibille
- Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium.,Institute of Health and Society, UCLouvain, Brussels, Belgium
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France. .,Unité VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France.
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18
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Type 2 Diabetes mellitus treatment intensification and deintensification in primary care: a retrospective cohort study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Bawazeer G, Alsaad S, Almalag H, Alqahtani A, Altulaihi N, Alodhayani A, AlHossan A, Sales I. Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital. Saudi Pharm J 2022; 30:1027-1035. [PMID: 35903532 PMCID: PMC9315319 DOI: 10.1016/j.jsps.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
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20
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Rakheja B, Sirois C, Ouellet N, Roux B, Laroche ML. Attitudes Toward Deprescribing in Older Adults and Caregivers: A Survey in Quebec, Canada. J Appl Gerontol 2022; 41:1376-1384. [PMID: 35246001 PMCID: PMC9024025 DOI: 10.1177/07334648211069553] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to describe attitudes toward deprescribing among older adults and caregivers. We recruited 110 adults 65 years and above using at least one prescribed medication for at least 3 months, and 95 unrelated caregivers (18+) of older adults with such characteristics, who answered the validated French version of the revised Patients’ Attitudes Towards Deprescribing questionnaire. More older adults (84.5%) than caregivers (70.5%) (p = .007) would be willing to stop at least one medication if the doctor said it was possible. Conversely, 93.5% of older adults and 78.9% of caregivers were satisfied with the current medications taken (p = .0024). The results did not vary according to age, sex, number of medications taken, education level, or residency. Thus, older adults and caregivers are disposed to undertake deprescribing, regardless of sociodemographic characteristics. However, relying solely on satisfaction with current medications may not be sufficient to identify relevant deprescribing opportunities.
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Affiliation(s)
- Bianca Rakheja
- Faculté de Médecine, 12369Université Laval, Québec, Canada
| | - Caroline Sirois
- Faculté de Pharmacie, 4440Université Laval, Québec, Canada.,Centre d'excellence sur le Vieillissement de Québec, Québec, Canada.,VITAM, Centre de Recherche en Santé durable, Québec, Canada
| | - Nicole Ouellet
- Département des Sciences Infirmières, 14846Université du Québec à Rimouski, Rimouski, Canada
| | - Barbara Roux
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur Les Médicaments, 36715CHU de Limoges, Limoges, France
| | - Marie-Laure Laroche
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur Les Médicaments, 36715CHU de Limoges, Limoges, France.,Laboratoire Vie-Santé, Faculté de Médecine de Limoges, Limoges, France
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Oktora MP, Edwina AE, Denig P. Differences in Older Patients' Attitudes Toward Deprescribing at Contextual and Individual Level. Front Public Health 2022; 10:795043. [PMID: 35223732 PMCID: PMC8874144 DOI: 10.3389/fpubh.2022.795043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deprescribing requires patients' involvement and taking patients' attitudes toward deprescribing into account. To understand the observed variation in these attitudes, the influence of contextual-level factors, such as country or healthcare setting, should be taken into account. Methods We conducted a systematic review of studies using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire among older adults. We searched articles in Medline and Embase up to 30 June 2021. PRISMA guideline was used for the search process and reporting. We summarized the outcomes from the rPATD and compared attitudes at study population level between high or low-middle-income countries, global regions, and healthcare settings using ANOVA testing. Correlations of the rPATD outcomes with the mean age of the study populations were tested. Associations with the rPATD outcomes at individual patient level extracted from the included studies were summarized. Results Sixteen articles were included. Percentages of patients willing to stop medication were significantly lower in low-middle-income countries (<70% in Nepal and Malaysia) compared to high-income countries (>85% in USA, Australia, European countries). No significant differences were observed when results were compared by global region or by healthcare setting but a high willingness (>95%) was seen in the two studies conducted in an inpatient population. A higher mean age at study level was associated with a higher willingness to stop medication. At individual level, associations between patient characteristics, including demographics and education, and attitudes toward deprescribing showed inconsistent results. Conclusion Findings about attitudes toward deprescribing are influenced by contextual factors. Future research should pay more attention to the influence of the healthcare system and setting as well as the culture on patients' attitudes.
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Affiliation(s)
- Monika Pury Oktora
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- *Correspondence: Monika Pury Oktora
| | - Angela Elma Edwina
- Faculty of Science and Engineering, Medical Pharmaceutical Sciences Programme, University of Groningen, Groningen, Netherlands
- Unit of Geriatrics and Gerontology, Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven, Belgium
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
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