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Chambers D, Preston L, Clowes M, Cantrell AJ, Goyder EC. Pharmacist-led primary care interventions to promote medicines optimisation and reduce overprescribing: a systematic review of UK studies and initiatives. BMJ Open 2024; 14:e081934. [PMID: 39117409 DOI: 10.1136/bmjopen-2023-081934] [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: 08/10/2024] Open
Abstract
OBJECTIVES To systematically review and synthesise evidence on the effectiveness and implementation barriers/facilitators of pharmacist-led interventions to promote medicines optimisation and reduce overprescribing in UK primary care. DESIGN Systematic review. SETTING UK primary care. METHODS We searched MEDLINE, Embase, CINAHL PsycINFO and The Cochrane Library for UK-based studies published between January 2013 and February 2023. Targeted searches for grey literature were conducted in May 2023. Quantitative and qualitative studies (including conference abstracts and grey literature) that addressed a relevant intervention and reported a primary outcome related to changes in prescribing were eligible for inclusion. Quality of included studies was assessed using the Multiple Methods Appraisal Tool. We performed a narrative synthesis, grouping studies by publication status, setting and type of data reported (effectiveness or implementation). RESULTS We included 14 peer-reviewed journal articles and 11 conference abstracts, together with 4 case study reports. The journal articles reported 10 different interventions, 5 delivered in general practice, 4 in care homes and 1 in community pharmacy. The quality of evidence was higher in general practice than in care home settings. It was consistently reported that the intervention improved outcomes related to prescribing, although the limited number of studies and wide range of outcomes reported made it difficult to estimate the size of any effect. Implementation was strongly influenced by relationships between pharmacists and other health and care professionals, especially general practitioners. Implementation in care homes appeared to be more complex than in general practice because of differences in systems and 'culture' between health and social care. CONCLUSIONS Pharmacist-led interventions have been reported to reduce overprescribing in primary care settings in the UK but a shortage of high-quality evidence means that more rigorous studies using high-quality designs are needed. More research is also needed in community pharmacy settings; to assess intervention effects on patient outcomes other than prescribing and to investigate how reducing overprescribing can impact health inequalities. PROSPERO REGISTRATION NUMBER CRD42023396366.
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Affiliation(s)
- Duncan Chambers
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Louise Preston
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Mark Clowes
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Anna J Cantrell
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Elizabeth C Goyder
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Sharkiya SH, Hag AM. Environmental and contextual factors influencing e-health use among older adults: A rapid review. Int J Med Inform 2024; 187:105448. [PMID: 38615510 DOI: 10.1016/j.ijmedinf.2024.105448] [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: 11/26/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION E-health services offer potential benefits for healthcare delivery, especially for older adults, yet their adoption remains suboptimal due to various barriers. Understanding the environmental and contextual factors influencing e-health use among this demographic is crucial for enhancing their health outcomes. AIM This rapid review aims to explore the various environmental and contextual factors affecting the use of e-health among older adults, focusing on identifying strategies to enhance acceptance and usefulness. METHODS Adhering to PRISMA guidelines, a mixed-methods rapid review was conducted following the Joanna Briggs Institute (JBI) guidelines. Databases including MEDLINE, EMBASE, Web of Science, Scopus, and Google Scholar were searched. Quantitative data were qualitized for integration with qualitative data, and a thematic analysis was performed on the assembled data. FINDINGS A total of 11 studies met the inclusion criteria, encompassing five cross-sectional surveys, four qualitative studies, one longitudinal study, and one Discrete Choice Experiment. The thematic analysis revealed five key themes: social influence and norms, environmental and infrastructure factors, economic factors and cost considerations, family and caregiver support, and organizational support and culture. CONCLUSION The review highlights the need for e-health solutions that enhance social support, are adaptable to diverse living environments, address economic barriers with cost-effective solutions, and are culturally sensitive to effectively engage older adults.
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Affiliation(s)
- Samer H Sharkiya
- DAROT Medical Center for Rehabilitation and Geriatrics in Israel, Israel.
| | - Anat M Hag
- Occupational Therapy Interventions for Older Adults and Memory Enhancement, Israel
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Morel T, Nguyen-Soenen J, Thompson W, Fournier JP. Development and validation of search filters to retrieve medication discontinuation articles in Medline and Embase. Health Info Libr J 2024; 41:156-165. [PMID: 38013506 DOI: 10.1111/hir.12516] [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: 12/22/2022] [Revised: 08/08/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Medication discontinuation studies explore the outcomes of stopping a medication compared to continuing it. Comprehensively identifying medication discontinuation articles in bibliographic databases remains challenging due to variability in terminology. OBJECTIVES To develop and validate search filters to retrieve medication discontinuation articles in Medline and Embase. METHODS We identified medication discontinuation articles in a convenience sample of systematic reviews. We used primary articles to create two reference sets for Medline and Embase, respectively. The reference sets were equally divided by randomization in development sets and validation sets. Terms relevant for discontinuation were identified by term frequency analysis in development sets and combined to develop two search filters that maximized relative recalls. The filters were validated against validation sets. Relative recalls were calculated with their 95% confidences intervals (95% CI). RESULTS We included 316 articles for Medline and 407 articles for Embase, from 15 systematic reviews. The Medline optimized search filter combined 7 terms. The Embase optimized search filter combined 8 terms. The relative recalls were respectively 92% (95% CI: 87-96) and 91% (95% CI: 86-94). CONCLUSIONS We developed two search filters for retrieving medication discontinuation articles in Medline and Embase. Further research is needed to estimate precision and specificity of the filters.
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Affiliation(s)
- Thomas Morel
- Département de Médecine Générale, Nantes Université, Nantes, France
- SPHERE-UMR INSERM 1246, Nantes Université, Université de Tours, Nantes, France
| | - Jérôme Nguyen-Soenen
- Département de Médecine Générale, Nantes Université, Nantes, France
- SPHERE-UMR INSERM 1246, Nantes Université, Université de Tours, Nantes, France
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Pascal Fournier
- Département de Médecine Générale, Nantes Université, Nantes, France
- SPHERE-UMR INSERM 1246, Nantes Université, Université de Tours, Nantes, 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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Guo Q, Jiang G, Zhao Q, Long Y, Feng K, Gu X, Xu Y, Li Z, Huang J, Du L. Rapid review: A review of methods and recommendations based on current evidence. J Evid Based Med 2024; 17:434-453. [PMID: 38512942 DOI: 10.1111/jebm.12594] [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: 12/26/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
Rapid review (RR) could accelerate the traditional systematic review (SR) process by simplifying or omitting steps using various shortcuts. With the increasing popularity of RR, numerous shortcuts had emerged, but there was no consensus on how to choose the most appropriate ones. This study conducted a literature search in PubMed from inception to December 21, 2023, using terms such as "rapid review" "rapid assessment" "rapid systematic review" and "rapid evaluation". We also scanned the reference lists and performed citation tracking of included impact studies to obtain more included studies. We conducted a narrative synthesis of all RR approaches, shortcuts and studies assessing their effectiveness at each stage of RRs. Based on the current evidence, we provided recommendations on utilizing certain shortcuts in RRs. Ultimately, we identified 185 studies focusing on summarizing RR approaches and shortcuts, or evaluating their impact. There was relatively sufficient evidence to support the use of the following shortcuts in RRs: limiting studies to those published in English-language; conducting abbreviated database searches (e.g., only searching PubMed/MEDLINE, Embase, and CENTRAL); omitting retrieval of grey literature; restricting the search timeframe to the recent 20 years for medical intervention and the recent 15 years for reviewing diagnostic test accuracy; conducting a single screening by an experienced screener. To some extent, the above shortcuts were also applicable to SRs. This study provided a reference for future RR researchers in selecting shortcuts, and it also presented a potential research topic for methodologists.
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Affiliation(s)
- Qiong Guo
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Guiyu Jiang
- West China School of Public Health, Sichuan University, Chengdu, P. R. China
| | - Qingwen Zhao
- West China School of Public Health, Sichuan University, Chengdu, P. R. China
| | - Youlin Long
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Kun Feng
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xianlin Gu
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yihan Xu
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
- Center for education of medical humanities, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Zhengchi Li
- Center for education of medical humanities, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Jin Huang
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Liang Du
- Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, P. R. China
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, P. R. China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P. R. China
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Hanneke R, Brunskill A. Searching for the social determinants of health: observations from evidence synthesis publications. Syst Rev 2024; 13:134. [PMID: 38755700 PMCID: PMC11097542 DOI: 10.1186/s13643-024-02551-y] [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] [Received: 11/29/2023] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The social determinants of health (SDOH) are the focus of an exponentially increasing number of publications, including evidence syntheses. However, there is not an established standard for searching for SDOH literature. This study seeks to identify published evidence syntheses pertaining to the SDOH, analyzing the search strategies used and the studies included within these reviews. The primary objectives are to compare search strategies and create a test set of SDOH publications. METHODS We searched PubMed, Embase, and Scopus for evidence syntheses that mentioned the SDOH in their research questions and included an SDOH search strategy. Relevant data extracted from each review included databases searched; search terms used for the SDOH; conceptual frameworks referenced; and the citations of primary studies included in the reviews, which were compiled to form a test set of cited papers. The relative recall of the respective search strategies was tested by documenting the total number of MEDLINE results each retrieved and the number of test set papers retrieved. RESULTS Sixty-four evidence syntheses were identified and included in the analysis, and 2750 cited papers were extracted. Findings indicate few commonalities across search strategies in search terms used, the total number of results retrieved, and the number of test set cited papers retrieved. One hundred and ninety-three unique MeSH terms and 1385 unique keywords and phrases were noted among the various search strategies. The number of total results retrieved by the SDOH search strategies ranged from 21,793 to over 16 million. The percentage of cited papers retrieved by the search strategies ranged from 2.46 to 97.9%. Less than 3% of the cited papers were indexed with the Social Determinants of Health MeSH. CONCLUSIONS There has been little consistency across evidence syntheses in approaches to searching for SDOH literature. Differences in these strategies could have a significant impact on what literature is retrieved, included in reviews, and, consequently, incorporated into evidence-based practice. By documenting these differences and creating a set of papers relevant to SDOH, this research provides a snapshot of the current challenges in searching for SDOH content and lays the groundwork for the creation of a standardized search approach for SDOH literature.
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Affiliation(s)
- Rosie Hanneke
- Library of the Health Sciences, University of Illinois Chicago, 1750 W Polk St. MC 763, Chicago, IL, 60612, USA.
| | - Amelia Brunskill
- Library of the Health Sciences, University of Illinois Chicago, 1750 W Polk St. MC 763, Chicago, IL, 60612, USA
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Mellot M, Jawal L, Morel T, Fournier JP, Tubach F, Cadwallader JS, Christiaens A, Zerah L. Barriers and Enablers for Deprescribing Glucose-Lowering Treatment in Older Adults: A Systematic Review. J Am Med Dir Assoc 2024; 25:439-447.e18. [PMID: 38237904 DOI: 10.1016/j.jamda.2023.11.025] [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: 08/31/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Overtreatment with glucose-lowering treatment (GLT) is frequent and a source of high morbidity and mortality in older adults with type 2 diabetes mellitus (T2DM). This study aimed to identify and synthesize barriers and enablers for deprescribing GLT in older adults (≥65 years) with T2DM. DESIGN Systematic review of qualitative and mixed-methods studies. SETTING AND PARTICIPANTS Older adults with T2DM, any participants [patients, health care providers (HCPs), caregivers], any settings. METHODS Two researchers (and a referred third researcher at all stages) independently screened original articles reporting qualitative and mixed-methods studies exploring barriers and enablers for deprescribing GLT in older adults published during 2010-2023, identified from MEDLINE, Embase, CINAHL, and gray literature. Quality of the included studies was assessed with the Mixed-Methods Appraisal Tool. Verbatim statements on barriers and enablers were extracted, and determinants of behaviors were identified with the Theoretical Domains Framework (TDF) version 2, and related intervention functions (targets for future interventions) were proposed according to the Behavior Change Wheel (BCW). RESULTS We identified only 4 studies from 2 countries (United States and the Netherlands), all recently published (2019-2023), that primarily reported barriers to GLT deprescribing from interviews or focus groups of patients or HCPs practicing outpatient medicine. Knowledge, fear, poor communication, inertia, and trust with HCPs were the main determinants of behaviors that influenced deprescribing, and education, training, persuasion and environmental restructuring were the main intervention functions for proposing future interventions. Studies did not cover financial aspects, physician characteristics, or caregiver and family viewpoints. CONCLUSIONS AND IMPLICATIONS The use of a behavioral theory and a validated implementation framework provided a comprehensive approach to identifying barriers and enablers for deprescribing GLT in older adults (≥65 years) with T2DM. The behavioral determinants identified may be useful in tailoring interventions to improve the implementation of GLT deprescribing in older adults in ambulatory settings.
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Affiliation(s)
- Marion Mellot
- Département de gériatrie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Paris, France
| | - Lina Jawal
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Thomas Morel
- Département de Médecine Générale, Faculté de Médecine, Nantes Université, Nantes, France
| | - Jean-Pascal Fournier
- Département de Médecine Générale, Faculté de Médecine, Nantes Université, Nantes, France; Université Tours-Nantes, INSERM, UMR U1246 SPHERE "Methods in Patient-Centered Outcomes and Health Research", Tours, France
| | - Florence Tubach
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Jean-Sébastien Cadwallader
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France; Département de Médecine Générale, Sorbonne Université, Paris, France
| | - Antoine Christiaens
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France; Fonds de la Recherche Scientifique (FNRS), Brussels, Belgium; Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium
| | - Lorène Zerah
- Département de gériatrie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France.
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