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Visser AGR, de-Bruijn JBGP, Spaetgens B, Winkens B, Janknegt R, Schols JMGA. Unlocking Deprescribing Potential in Nursing Homes: Insights from a Focus Group Study with Healthcare Professionals. Drugs Aging 2024; 41:261-270. [PMID: 38285238 PMCID: PMC10925566 DOI: 10.1007/s40266-023-01092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The nursing home population is characterized by multimorbidity and disabilities, which often result in extensive prescription of medication and subsequent polypharmacy. Deprescribing, a planned and supervised process of dose reduction or total cessation of medication, is a solution to combat this. OBJECTIVE This study aimed to identify barriers and enablers of deprescribing as experienced by nursing home physicians (NHPs) and collaborating pharmacists in the specific nursing home setting. METHODS This qualitative study utilized a semi-structured interview format with two focus groups consisting of a mix of NHPs and pharmacists. Directed content analysis was performed based on the Theoretical Domains Framework, a validated framework for understanding determinants of behavior change among health care professionals. RESULTS Sixteen health care professionals participated in two focus groups, including 13 NHPs and three pharmacists. The participating NHPs and pharmacists believed that deprescribing is a valuable process with enablers, such as multidisciplinary collaboration, good communication with patients and family, and involvement of the nursing staff. NHPs and pharmacists view deprescribing as a core task and feel assured in their ability to carry it out successfully. However, they also noted barriers: deprescribing is time-consuming; communication with residents, their relatives or medical specialists is difficult; and electronic patient systems often do not adequately support it. CONCLUSIONS This study provides insight into the various barriers and enablers faced by NHPs and pharmacists when deprescribing in nursing homes. Specific for this population, deprescribing barriers focus on communication (with residents and their relatives, and also with medical specialists) and resources, while knowledge and expertise are mentioned as enablers.
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Affiliation(s)
- Anne G R Visser
- Zuyderland Nursing Homes, Sittard, The Netherlands.
- Departments of Health Services Research and Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Jenny B G Poddighe de-Bruijn
- Departments of Health Services Research and Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Rob Janknegt
- Zuyderland Nursing Homes, Sittard, The Netherlands
| | - Jos M G A Schols
- Departments of Health Services Research and Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Jerjes W, Harding D. De-prescribing in primary care: the clinical, ethical and psychological considerations. J Prim Health Care 2024; 16:96-98. [PMID: 38546783 DOI: 10.1071/hc23118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Waseem Jerjes
- North End Medical Centre, Hammersmith and Fulham Partnership, London, UK; and Research and Development Unit, Hammersmith and Fulham Primary Care Network, London, UK; and Faculty of Medicine, Imperial College, London, UK
| | - Daniel Harding
- North End Medical Centre, Hammersmith and Fulham Partnership, London, UK
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3
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Robinson M, Mokrzecki S, Mallett AJ. Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review. NPJ AGING 2024; 10:6. [PMID: 38263176 PMCID: PMC10806180 DOI: 10.1038/s41514-023-00132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024]
Abstract
Polypharmacy, commonly defined as ≥5 medications, is a rising public health concern due to its many risks of harm. One commonly recommended strategy to address polypharmacy is medication reviews, with subsequent deprescription of inappropriate medications. In this review, we explore the intersection of older age, polypharmacy, and deprescribing in a contemporary context by appraising the published literature (2012-2022) to identify articles that included new primary data on deprescribing medications in patients aged ≥65 years currently taking ≥5 medications. We found 31 articles were found which describe the current perceptions of clinicians towards deprescribing, the identified barriers, key enabling factors, and future directions in approaching deprescribing. Currently, clinicians believe that deprescribing is a complex process, and despite the majority of clinicians reporting feeling comfortable in deprescribing, fewer engage with this process regularly. Common barriers cited include a lack of knowledge and training around the deprescribing process, a lack of time, a breakdown in communication, perceived 'abandonment of care', fear of adverse consequences, and resistance from patients and/or their carers. Common enabling factors of deprescribing include recognition of key opportunities to instigate this process, regular medication reviews, improving lines of communication, education of both patients and clinicians and a multidisciplinary approach towards patient care. Addressing polypharmacy requires a nuanced approach in a generally complex group of patients. Key strategies to reducing the risks of polypharmacy include education of patients and clinicians, in addition to improving communication between healthcare providers in a multidisciplinary approach.
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Affiliation(s)
- Michael Robinson
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Sophie Mokrzecki
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
- Department of Pharmacy, Townsville University Hospital, Douglas, QLD, Australia
| | - Andrew J Mallett
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, QLD, Australia.
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
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4
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Vordenberg SE, Rana R, Shang J, Choi J, Scherer AM, Weir KR. Reasons why older adults in three countries agreed with a deprescribing recommendation in a hypothetical vignette. Basic Clin Pharmacol Toxicol 2023; 133:673-682. [PMID: 36894739 DOI: 10.1111/bcpt.13857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
The purpose of this study was to examine factors important to older adults who agreed with a deprescribing recommendation given by a general practitioner (GP) to a hypothetical patient experiencing polypharmacy. We conducted an online, vignette-based, experimental study in the United Kingdom, United States and Australia with participants ≥65 years. The primary outcome was an agreement with a deprescribing recommendation (6-point Likert scale; 1 = strongly disagree and 6 = strongly agree). We performed a content analysis of the free-text reasons provided by participants who agreed with deprescribing (score of 5 or 6). Among 2656 participants who agreed with deprescribing, approximately 53.7% shared a preference for following the GP's recommendation or considered the GP the expert. The medication was referred to as a reason for deprescribing by 35.6% of participants. Less common themes included personal experience with medicine (4.3%) and older age (4.0%). Older adults who agreed with deprescribing in a hypothetical vignette most frequently reported a desire to follow the recommendations given the GP's expertise. Future research should be conducted to help clinicians efficiently identify patients who have a strong desire to follow the doctor's recommendations related to deprescribing, as this may allow for a tailored, brief deprescribing conversation.
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Affiliation(s)
- Sarah E Vordenberg
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
- University of Michigan Center for Bioethics and Social Sciences in Medicine, 28000 Plymouth Rd, Ann Arbor, MI 48019, Michigan, USA
| | - Ruchi Rana
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Jenny Shang
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Jae Choi
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Aaron M Scherer
- University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, Iowa, USA
| | - Kristie Rebecca Weir
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
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Campbell NL. Building Demand for Deprescribing Expertise: Pharmacists as Deprescribing Care Coordinators. Sr Care Pharm 2023; 38:3-4. [PMID: 36751920 DOI: 10.4140/tcp.n.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A number of barriers to deprescribing exist, with knowledge, skills, and self-efficacy often highlighted by prescribers within an interrupted, siloed nature of the existing health care system. Thus, deprescribing is not likely to occur without a change in the system. Pharmacists are extremely well positioned to positively impact the deprescribing process, and particularly senior care pharmacists given familiarity with population-specific pharmacodynamic and pharmacokinetic characteristics of medications. Similarly, our health care partners have endorsed pharmacists to not only collaborate but to drive the deprescribing trials. Therefore, no other profession is better positioned to advocate for the value of deprescribing as a core component of the pharmaceutical care process.
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Affiliation(s)
- Noll L Campbell
- Department of Pharmacy Practice Purdue University College of Pharmacy West Lafayette, Indiana Indiana University Center for Aging Research Regenstrief Institute Indiana University Center for Healthcare Innovation and Implementation Science Indianapolis, Indiana
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Lukacena KM, Keck JW, Freeman PR, Harrington NG, Huffmyer MJ, Moga DC. Patients' attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists. Ther Adv Drug Saf 2022; 13:20420986221116465. [PMID: 36003624 PMCID: PMC9393353 DOI: 10.1177/20420986221116465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Developing effective deprescribing interventions relies on understanding
attitudes, beliefs, and communication challenges of those involved in the
deprescribing decision-making process, including the patient, the primary
care clinician, and the pharmacist. The objective of this study was to
assess patients’ beliefs and attitudes and identify facilitators of and
barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18 years of age taking ⩾3
chronic medications. Participants were recruited from retail pharmacies
associated with the University of Kentucky HealthCare system. They completed
an electronic survey that included demographic information, questions about
communication with their primary care clinician and pharmacists, and the
revised Patients’ Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants (n = 65 identified as
female and n = 74 as White/Caucasian) with a mean age of
50.4 years [standard deviation (SD) = 15.5]. Participants reported taking an
average of 8.4 daily medications (SD = 6.1). Most participants reported
effective communication with clinicians and pharmacists (66.9%) and
expressed willingness to stop one of their medications if their clinician
said it was possible (83.5%). Predictors of willingness to accept
deprescribing were older age [odds ratio (OR) = 2.99, 95% confidence
interval (CI) = 1.45–6.2], college/graduate degree (OR = 55.25, 95%
CI = 5.74–531.4), perceiving medications as less appropriate (OR = 8.99, 95%
CI = 1.1–73.62), and perceived effectiveness of communication with the
clinician or pharmacist (OR = 4.56, 95% CI = 0.85–24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept
deprescribing of medications when their doctor said it was possible.
Targeted strategies to facilitate communication within the patient–primary
care clinician–pharmacist triad that consider patient characteristics such
as age and education level may be necessary ingredients for developing
successful deprescribing interventions. Plain Language Summary Are patients willing to accept stopping medications? Sometimes, medicines that a patient takes regularly become inappropriate. In
other words, the risks of adverse effects might be greater than a medicine’s
potential benefits. The decision to stop such medicines should involve the
patient and consider their preferences. We surveyed a group of patients
taking multiple medicines to see how they felt about having those medicines
stopped. We also asked patients whether and how much they talk to their
primary care clinician and pharmacists about their medicines. To qualify for
this study, patients had to be at least 18 years old and to take three or
more medicines daily; they also needed to speak English. Participants
provided demographic information and answered questions about their
medicines, their communication with primary care clinicians and pharmacists,
and their feelings about having one or more of their medicines stopped. We
recruited 107 people and were able to use responses from 103 of them. Their
average age was 50 years; 65 of them identified as female, and 75 identified
as White/Caucasian. Most of our participants mentioned having conversations
with primary care clinicians and pharmacists and said they would be willing
to stop a medication if their clinician said it was possible. Older
participants, those with more years of education, those who thought their
medications might lead to side effects, and those who communicated with
their clinician or pharmacists were more willing to have one of their
medicines stopped. Our results indicate that patient characteristics and communication with
clinicians and pharmacists are factors to consider when designing
interventions to reduce the use of inappropriate medicines.
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Affiliation(s)
- Kaylee M Lukacena
- Center for Social and Behavioral Science, Office of the Vice Chancellor for Research and Innovation, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - James W Keck
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Nancy Grant Harrington
- Department of Communication, College of Communication and Information, University of Kentucky, Lexington, KY, USA
| | - Mark J Huffmyer
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Daniela C Moga
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA. Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
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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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Trenaman SC, Kennie-Kaulbach N, d'Entremont-MacVicar E, Isenor JE, Goodine C, Jarrett P, Andrew MK. Implementation of pharmacist-led deprescribing in collaborative primary care settings. Int J Clin Pharm 2022; 44:1216-1221. [PMID: 35794285 PMCID: PMC9261167 DOI: 10.1007/s11096-022-01449-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
In many jurisdictions pharmacists share prescribing responsibilities with other members of the primary care team. Responsibility for deprescribing, the healthcare professional supervised withdrawal of medications that are no longer needed, has not been assumed by a specific member of the primary care team. In this commentary we describe implementation of pharmacist-led deprescribing in collaborative primary care settings using the seven components of knowledge translation. Patient and stakeholder engagement shaped the deprescribing intervention. The intervention was implemented in three collaborative primary care clinics in two Canadian provinces. The evaluation included measures of medication appropriateness, patient satisfaction, and healthcare professional satisfaction. Pharmacist-led deprescribing in primary care was acceptable to both patients and healthcare professionals and demonstrated a reduction of medications deemed to confer more risk than benefit. Our findings support successes in pharmacist-led deprescribing. Future work is needed to understand how to successfully implement and evaluate pharmacist-led deprescribing more widely.
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Affiliation(s)
- Shanna C Trenaman
- Department of Medicine (Geriatrics), Dalhousie University, Veterans Memorial Building, 5955 Veterans Memorial Lane, Halifax, NS, B3H 2E1, Canada.
- Geriatric Medicine Research, Dalhousie University / Nova Scotia Health Authority, 1427-5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.
| | - Natalie Kennie-Kaulbach
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | | | - Jennifer E Isenor
- College of Pharmacy, Faculty of Health, Dalhousie University, 5968 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada
- Department of Community Health and Epidemiology, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Carole Goodine
- Horizon Health Network, Doctor Everett Chalmers Hospital, 700 Priestman Street, PO Box 9000, Fredericton, NB, E3B 5N5, Canada
| | - Pamela Jarrett
- Department of Medicine (Geriatrics), Dalhousie University, Veterans Memorial Building, 5955 Veterans Memorial Lane, Halifax, NS, B3H 2E1, Canada
- Horizon Health Network, 400 University Avenue, PO Box 2100, Saint John, NB, E2L 4L2, Canada
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Veterans Memorial Building, 5955 Veterans Memorial Lane, Halifax, NS, B3H 2E1, Canada
- Geriatric Medicine Research, Dalhousie University / Nova Scotia Health Authority, 1427-5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
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9
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Mohottige D, Manley HJ, Hall RK. Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review. KIDNEY360 2021; 2:1510-1522. [PMID: 35373095 PMCID: PMC8786141 DOI: 10.34067/kid.0001942021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
Due to age and impaired kidney function, older adults with kidney disease are at increased risk of medication-related problems and related hospitalizations. One proa ctive approach to minimize this risk is deprescribing. Deprescribing refers to the systematic process of reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients' quality of life by aligning medications with their goals of care. For some patients, deprescribing could involve less aggressive management of their diabetes and/or hypertension. In other instances, deprescribing targets may include potentially inappropriate medications that carry greater risk of harm than benefit in older adults, medications that have questionable efficacy, including medications that have varying efficacy by degree of kidney function, and that increase medication regimen complexity. We include a guide for clinicians to utilize in deprescribing, the List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations at each step of the deprescribing process that can be tailored for the medications and context of individu al patients. Patient characteristics or clinical events that warrant consideration of deprescribing include limited life expectancy, cognitive impairment, and health status changes, such as dialysis initiation or recent hospitalization. We acknowledge patient-, clinician-, and system-level challenges to the depre scribing process. These include patient hesitancy and challenges to discussing goals of care, clinician time constraints and a lack of evidence-based guidelines, and system-level challenges of interoperable electronic health records and limited incentives for deprescribing. However, novel evidence-based tools designed to facilitate deprescribing and future evidence on effectiveness of deprescribing could help mitigate these barriers. This review provides foundational knowledge on deprescribing as an emerging component of clinical practice and research within nephrology.
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Affiliation(s)
- Dinushika Mohottige
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Rasheeda K. Hall
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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