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Harding SL, Ellis KA, Boisseau J, Petreca V. Psychiatric Deprescribing: A Narrative Review. J Am Psychiatr Nurses Assoc 2024; 30:810-818. [PMID: 37392084 DOI: 10.1177/10783903231185353] [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: 07/02/2023]
Abstract
OBJECTIVE Psychiatric deprescribing is an intervention where psychiatric medications are reduced or discontinued with the goal to improve health and reduce unnecessary risks. The purpose of this study was to synthesize the literature related to psychiatric deprescribing to discuss practice and research implications. METHODS A structured search of the literature was conducted from May to September 2022, yielding 29 articles meeting inclusion criteria. Articles were reviewed and synthesized. RESULTS Psychiatric deprescribing is a complex process with many potential facilitators and barriers. The extant literature provides insight into current gaps in knowledge and implications for clinical practice and research. CONCLUSIONS In current clinical practice, psychiatric deprescribing is a priority but there are significant barriers. Several areas of future research could be pursued to better support evidence-based practice in this area.
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Affiliation(s)
- Shari L Harding
- Shari L. Harding, DNP, PMHNP-BC, CPRP, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kerri A Ellis
- Kerri A. Ellis, DNP, ACNP-BC, PMHNP-BC, The University of Rhode Island, Kingston, RI, USA
| | - John Boisseau
- John Boisseau, DNP, PMHNP-BC, LifeStance Health, Inc., Boston, MA, USA
| | - Victor Petreca
- Victor Petreca, PhD, DNP, PMHNP-BC, Boston College, Chestnut Hill, MA, USA
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Carollo M, Boccardi V, Crisafulli S, Conti V, Gnerre P, Miozzo S, Omodeo Salè E, Pieraccini F, Zamboni M, Marengoni A, Onder G, Trifirò G. Medication review and deprescribing in different healthcare settings: a position statement from an Italian scientific consortium. Aging Clin Exp Res 2024; 36:63. [PMID: 38459218 PMCID: PMC10923734 DOI: 10.1007/s40520-023-02679-2] [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: 11/22/2023] [Accepted: 12/17/2023] [Indexed: 03/10/2024]
Abstract
Recent medical advancements have increased life expectancy, leading to a surge in patients affected by multiple chronic diseases and consequent polypharmacy, especially among older adults. This scenario increases the risk of drug interactions and adverse drug reactions, highlighting the need for medication review and deprescribing to reduce inappropriate medications and optimize therapeutic regimens, with the ultimate goal to improving patients' health and quality of life. This position statement from the Italian Scientific Consortium on medication review and deprescribing aims to describe key elements, strategies, tools, timing, and healthcare professionals to be involved, for the implementation of medication review and deprescribing in different healthcare settings (i.e., primary care, hospital, long-term care facilities, and palliative care). Challenges and potential solutions for the implementation of medication review and deprescribing are also discussed.
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Affiliation(s)
- Massimo Carollo
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Salvatore Crisafulli
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy
| | - Valeria Conti
- Clinical Pharmacology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Simonetta Miozzo
- Italian Society of General Medicine and Primary Care, Florence, Italy
| | - Emanuela Omodeo Salè
- Division of Pharmacy, IEO European Institute of Oncology IRCCS, Milan, Italy
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | - Mauro Zamboni
- Department of Medicine-Geriatric Division, University of Verona, Verona, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Graziano Onder
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, P.Le L.A. Scuro 10, 37124, Verona, Italy.
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Bužančić I, Ortner Hadžiabdić M. Differences in Factors Influencing Deprescribing between Primary Care Providers: Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4957. [PMID: 36981865 PMCID: PMC10049550 DOI: 10.3390/ijerph20064957] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Deprescribing is a notable approach to improve medication management, but few healthcare systems recognize it. To introduce a new practice, it is important to examine the factors influencing the provision of a new or elaborate cognitive service within the desired setting. This study explores the perceived barriers and facilitators of deprescribing by primary healthcare providers, and identifies the factors associated with a willingness to suggest deprescribing. A cross-sectional survey was conducted (in Croatia, between October 2021 and January 2022) using a validated comprehensive healthcare providers' opinions, preferences, and attitudes towards deprescribing (CHOPPED) questionnaire. A total of 419 pharmacists and 124 physicians participated. Participants showed a high willingness to deprescribe, with significantly higher scores in physicians than in pharmacists (5.00 (interquartile range-IQR 5-5) vs. 4.00 (IQR 4-5), p < 0.001). Pharmacists had significantly higher scores in seven out of ten factors (knowledge, awareness, collaboration facilitators, competencies facilitators, healthcare system facilitators, collaboration barriers, competencies barriers) while in the remaining three factors (patient facilitators, patient and healthcare system barriers) there was no difference in scores. The strongest positive correlation with willingness to suggest deprescribing was found with the collaboration and healthcare system facilitators factors for pharmacists (G = 0.331, p < 0.001, and G = 0.309, p < 0.001, respectively), and with knowledge, awareness, and patient facilitators factors for physicians (G = 0.446, p = 0.001; G = 0.771, p < 0.001; and G = 0.259, p = 0.043, respectively). Primary healthcare providers are willing to suggest deprescribing but face different barriers and facilitators. For pharmacists, the most important facilitators were extrinsic, while for physicians they were more intrinsic and patient related. The stated results provide target areas which one could focus upon to help to engage healthcare providers in deprescribing.
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Affiliation(s)
- Iva Bužančić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, A. Kovačića 1, 10 000 Zagreb, Croatia
- City Pharmacies Zagreb, Kralja Držislava 6, 10 000 Zagreb, Croatia
| | - Maja Ortner Hadžiabdić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, A. Kovačića 1, 10 000 Zagreb, Croatia
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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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Bužančić I, Ortner Hadžiabdić M. Development and Validation of Comprehensive Healthcare Providers' Opinions, Preferences, and Attitudes towards Deprescribing (CHOPPED Questionnaire). PHARMACY 2022; 10:76. [PMID: 35893715 PMCID: PMC9326567 DOI: 10.3390/pharmacy10040076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
Successful implementation of deprescribing requires exploring healthcare professionals’ opinions, preferences, and attitudes towards deprescribing. The aim of this study was to develop and validate the questionnaire exploring healthcare providers’ opinions preferences and attitudes towards deprescribing (CHOPPED questionnaire). This was a cross-sectional on-line survey. A comprehensive 58-item questionnaire, in two versions (for pharmacists and physicians), was developed through an extensive literature review and interviews with experts. The questionnaire was validated, and its reliability was assessed through data collected from 356 pharmacists and 109 physicians. Exploratory factor analysis was performed, and 37- and 35-item questionnaires were developed. Ten factors were identified: knowledge, awareness, patient barriers and facilitators, competencies barriers and facilitators, collaboration barriers and facilitators, and healthcare system barriers and facilitators. The CHOPPED tool has satisfactory face, content (CVR > 0.62) (content validity ratio), construct, and criterion validity. The reliability statistics of all factors in both versions was acceptable with Cronbach’s alpha > 0.6. Test−retest reliability analysis showed that gamma rank correlations of total factor scores were strong and very strong (between 0.519 and 0.938). The CHOPPED tool can be used as a valid and reliable tool to explore healthcare providers’ opinions and attitudes toward discontinuing medications in the primary care setting in Croatia.
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Affiliation(s)
- Iva Bužančić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, A. Kovačića 1, 10 000 Zagreb, Croatia;
- City Pharmacies Zagreb, Kralja Držislava 6, 10 000 Zagreb, Croatia
| | - Maja Ortner Hadžiabdić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, A. Kovačića 1, 10 000 Zagreb, Croatia;
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Kalim RA, Cunningham CJ, Ryder SA, McMahon NM. Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF). Drugs Aging 2022; 39:935-947. [PMID: 36409404 PMCID: PMC9676799 DOI: 10.1007/s40266-022-00985-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Falls can lead to hospitalisation and death in older people. Polypharmacy is a major risk factor, and deprescribing fall-risk increasing drugs (FRIDs) is one of several possible important preventive measures. The objective of this study was to explore the factors that influence doctors when deprescribing FRIDs in a hospital setting. METHOD Semi-structured interviews were conducted with consultant geriatricians and hospital doctors experienced in dealing with patients aged 65 years or older, at a large academic teaching hospital (~ 1000 beds), Dublin, Ireland. The interviews were directed by an interview guide and audio recorded and transcribed verbatim, with subsequent thematic analysis in NVivo 12 software. RESULTS A total of 18 participants were interviewed. Barriers to deprescribing included: insufficient time, incomplete patient records, changing medications initiated by other specialists and difficulties following up patients after discharge. Facilitators included: enhanced documentation through electronic patient records, the support of other healthcare professionals such as clinical pharmacists, and patients' engagement, which is considered essential for the success of the deprescribing process's outcome. CONCLUSION Deprescribing FRIDs in older adults in the hospital setting is challenging. Implementation of the process in practice requires combined effort from stakeholders to tackle everyday work environment challenges. Future studies are required examining the clinical effect of the suggested interventions and exploring patients' involvement in deprescribing decisions.
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Affiliation(s)
- Reham A Kalim
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Conal J Cunningham
- St James's Hospital, James's Street, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sheila A Ryder
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
| | - Niamh M McMahon
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- St James's Hospital, James's Street, Dublin, Ireland
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Kilańska D, Lipert A, Guzek M, Engelseth P, Marczak M, Sienkiewicz K, Kozłowski R. Increased Accessibility to Primary Healthcare Due to Nurse Prescribing of Medicines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010292. [PMID: 35010551 PMCID: PMC8751194 DOI: 10.3390/ijerph19010292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 06/04/2023]
Abstract
Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe medicines. Consequently, Polish patients received the same opportunity as in other countries worldwide: easier access to certain health services, i.e., medical prescribing. The aim of this study was to assess the impact of structural changes which increased the nurses' competences on the accessibility to prescription visits for patients receiving primary healthcare on the example of Medical and Diagnostic Centre (MDC), and to discuss the general trend of legal changes in nursing profession regulations. We performed a detailed analysis of the data on the MDC patient population in Siedlce who received at least one prescription written by a general practitioner and/or a nurse/midwife in the years 2017-2019.The largest number of prescription visits made by nurses concerned patients aged 50-70 years, as this age range includes the largest number of patients with chronic diseases who need continued pharmacological treatment originally administered by doctors. An increasing tendency for prescription visits made by nurses was recorded, with a simultaneous downward trend in the same type of visits undertaken by doctors at MDC. Nurses' involvement in prescribing medications as a continued pharmacotherapy during holiday seasons results in patients having continuous access to medication. An upward trend was also observed in the number of medications prescribed by nurses per patient. Structural changes in the legal regulations of the nursing profession improve patients' access to prescription visits under primary healthcare. Further research is recommended to evaluate the dynamics of these trends and the impact of newly introduced nursing competences on the accessibility of prescription visits for patients.
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Affiliation(s)
- Dorota Kilańska
- Department of Coordinated Care, Medical University of Lodz, 90-131 Lodz, Poland;
| | - Anna Lipert
- Department of Sports Medicine, Medical University of Lodz, 92-213 Lodz, Poland
| | - Marika Guzek
- Medical and Diagnostic Center (MCM), 08-110 Siedlce, Poland;
| | - Per Engelseth
- Narvik Campus, Tromsø School of Business and Economics, The Arctic University of Norway, 8505 Narvik, Norway;
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.S.)
| | - Kamila Sienkiewicz
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.S.)
| | - Remigiusz Kozłowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
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De Baetselier E, Dilles T, Batalha LM, Dijkstra NE, Fernandes MI, Filov I, Friedrichs J, Grondahl VA, Heczkova J, Helgesen AK, Jordan S, Keeley S, Klatt T, Kolovos P, Kulirova V, Ličen S, Lillo-Crespo M, Malara A, Padysakova H, Prosen M, Pusztai D, Riquelme-Galindo J, Rottkova J, Sino CG, Talarico F, Tziaferi S, Van Rompaey B. Perspectives of nurses' role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses. PLoS One 2021; 16:e0251982. [PMID: 34043650 PMCID: PMC8158867 DOI: 10.1371/journal.pone.0251982] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC). DESIGN Qualitative study conducted through semi-structured in-depth interviews. SETTING Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. PARTICIPANTS In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. DATA COLLECTION AND ANALYSIS All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. RESULTS 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. CONCLUSIONS European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.
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Affiliation(s)
- Elyne De Baetselier
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Tinne Dilles
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luis M. Batalha
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Nienke E. Dijkstra
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Maria I. Fernandes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Izabela Filov
- University "St. Kliment Ohridski" Bitola, Bitola, Republic of North-Macedonia
| | - Juliane Friedrichs
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Vigdis A. Grondahl
- Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Jana Heczkova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, Halden, Norway
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea, Wales, United Kingdom
| | - Sarah Keeley
- Department of Nursing and Clinical Science, Bournemouth University, Bournemouth, England, United Kingdom
| | - Thomas Klatt
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Petros Kolovos
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Sparti, Greece
| | - Veronika Kulirova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sabina Ličen
- Faculty of Health Sciences, Department of Nursing, University of Primorska, Izola, Slovenia
| | - Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | | | - Hana Padysakova
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, Bratislava, Slovak Republic
| | - Mirko Prosen
- Faculty of Health Sciences, Department of Nursing, University of Primorska, Izola, Slovenia
| | - Dorina Pusztai
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Jorge Riquelme-Galindo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Jana Rottkova
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, Bratislava, Slovak Republic
| | - Carolien G. Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | | | - Styliani Tziaferi
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Sparti, Greece
| | - Bart Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Ng B, Duong M, Lo S, Le Couteur D, Hilmer S. Deprescribing perceptions and practice: Reported by multidisciplinary hospital clinicians after, and by medical students before and after, viewing an e-learning module. Res Social Adm Pharm 2021; 17:1997-2005. [PMID: 33773940 DOI: 10.1016/j.sapharm.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND There are many barriers to deprescribing in the routine care of older inpatients with polypharmacy. Implementation is limited by factors related to clinicians, patients, and the acute care setting. A short (11 min) e-learning module for multidisciplinary hospital clinicians was developed to address two commonly reported barriers: awareness of polypharmacy and self-efficacy in deprescribing. OBJECTIVES 1) Describe the level of awareness of polypharmacy and self-efficacy of deprescribing in multi-disciplinary hospital clinicians following completion of an online e-learning module; and 2) describe the immediate impact of an online educational module in awareness and self-efficacy of polypharmacy and deprescribing in senior medical students. METHODS A questionnaire was developed and administered to hospital clinicians following completion of the e-learning module. Senior medical students undertook the questionnaire pre- and post-module. RESULTS Overall, 99 hospital clinicians with diverse clinical roles, experience, and ages, and 30 medical students completed the questionnaire. Although most (≥80%) hospital clinicians reported a general awareness of polypharmacy and deprescribing, there was moderate to low current activity in medication review and deprescribing, a perceived lack of role in medication review by junior doctors, and minimal knowledge of deprescribing tools. Use of a previously validated self-efficacy questionnaire showed lowest self-efficacy in domains related to developing deprescribing plans and implementing them. Pre-post analysis of medical student responses found a small statistically significant improvement following viewing the module in awareness of polypharmacy, deprescribing and deprescribing tools, perception of their role in deprescribing, and self-efficacy in planning and implementation of deprescribing decisions. CONCLUSIONS Hospital clinicians and senior medical students had limited self-efficacy in deprescribing and hospital clinicians reported they did not deprescribe frequently. Targets for educational and behavioral interventions were identified. A short e-learning module on polypharmacy and deprescribing may be a useful component of a multi-strategic intervention to implement deprescribing into routine inpatient care.
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Affiliation(s)
- Brendan Ng
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia; Capital and Coast District Health Board, Wellington, New Zealand.
| | - Mai Duong
- Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Sarita Lo
- Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - David Le Couteur
- University of Sydney and Concord Hospital, Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | - Sarah Hilmer
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
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