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Lundby C, Farrell B, Wilson A. Anticholinergic deprescribing: A case report demonstrating improved cognition and function with minimal adverse withdrawal effects. Br J Clin Pharmacol 2024. [PMID: 38697619 DOI: 10.1111/bcp.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Anticholinergic-induced cognitive impairment may be partially reversible upon cessation. A barrier to deprescribing of anticholinergics is the unknown risk of anticholinergic adverse drug withdrawal events (ADWE), with only limited information available on the incidence, timing and severity of anticholinergic ADWE. We report the case of a 76-year-old woman who experienced significant cognitive improvement following deprescribing long-term use of a strong anticholinergic drug, doxepin, and dose reduction of another possible anticholinergic agent. The patient decided to abruptly stop taking doxepin, despite a planned careful taper with twice weekly monitoring, but did not experience any severe anticholinergic ADWE and subsequently had significantly improved cognitive function. Future research should focus on better understanding the risk of anticholinergic ADWE so that anticholinergic deprescribing decisions, including how often and by how much to taper, can be made confidently and safely.
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Affiliation(s)
- Carina Lundby
- Geriatric Day Hospital, Bruyère Continuing Care, Ottawa, Canada
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense M, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense M, Denmark
| | - Barbara Farrell
- Geriatric Day Hospital, Bruyère Continuing Care, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - Amanda Wilson
- Geriatric Day Hospital, Bruyère Continuing Care, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
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2
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Farrell B. Engaging patients in conversations about deprescribing. Expert Rev Clin Pharmacol 2024:1-4. [PMID: 38618915 DOI: 10.1080/17512433.2024.2343913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/12/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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Schneider T, Farrell B, Karunananthan S, Afkham A, Keely E, Liddy C, McCarthy LM. Classification system for primary care provider eConsults about medications for older adults with frailty. BMC Prim Care 2024; 25:104. [PMID: 38565981 PMCID: PMC10985926 DOI: 10.1186/s12875-024-02340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Providing primary care for people with frailty can be challenging due to an increased risk of adverse outcomes and use of potentially inappropriate medications which may exacerbate characteristics of frailty. eConsult is a service where primary care providers can receive timely specialist advice for their patients through a secure web-based application. We aimed to develop a classification system to characterize medication-focused eConsult questions for older adults with frailty and assess its usability. METHODS A classification system was developed and refined over three cycles of improvement through a cross-sectional study of 35 cases categorized as medication-focused from cases submitted in 2019 for patients aged 65 or older with frailty through the Champlain BASE eConsult service (Ontario, Canada). The final classification system was then applied to each case. RESULTS The classification system contains 5 sections: (1) case descriptives; (2) intent and type of question; (3) medication recommendations and additional information in the response; (4) medication classification; and (5) potentially inappropriate medications. Among the 35 medication-focused cases, the most common specialties consulted were endocrinology (9 cases, 26%) and cardiology (5 cases, 14%). Medication histories were available for 29 cases (83%). Many patients were prescribed potentially inappropriate medications based on explicit tools (AGS Beers Criteria®, STOPPFall, Anticholinergic Cognitive Burden Scale, ThinkCascades) yet few consults inquired about these medications. CONCLUSION A classification system to describe medication-related eConsult cases for patients experiencing frailty was developed and applied to 35 eConsult cases. It can be applied to more cases to identify professional development opportunities and enhancements for eConsult services.
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Affiliation(s)
- T Schneider
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - B Farrell
- Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - S Karunananthan
- Bruyère Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - A Afkham
- Ontario Health East, Ottawa, Canada
| | - E Keely
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - C Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - L M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
- Bruyère Research Institute, Ottawa, Canada.
- School of Pharmacy, University of Waterloo, Waterloo, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada.
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Thompson W, Reeve E, McDonald EG, Farrell B, Scott S, Steinman MA, Morin L, Lundby C. Ten deprescribing articles you should know about: A guide for newcomers to the field. Basic Clin Pharmacol Toxicol 2023; 133:661-664. [PMID: 37142559 PMCID: PMC10831497 DOI: 10.1111/bcpt.13877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Emily Reeve
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, VIC, Australia
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, SA, Australia
| | - Emily G. McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Barbara Farrell
- Bruyere Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- University of Waterloo School of Pharmacy, Waterloo, Canada
| | - Sion Scott
- School of Healthcare, University of Leicester, United Kingdom
| | - Michael A. Steinman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, California, USA
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Inserm CIC 1431, CHU Besançon, Besançon, France
- Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
| | - Carina Lundby
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
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Farrell B, Famiyeh IM, Preteroti M, Vuong V. Ten years of deprescribing guideline work: Where are we now? Can Fam Physician 2023; 69:666-669. [PMID: 37833083 PMCID: PMC10575655 DOI: 10.46747/cfp.6910666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Affiliation(s)
- Barbara Farrell
- Senior Scientist at the Bruyère Research Institute in Ottawa, Ont; Assistant Professor in the Department of Family Medicine at the University of Ottawa; and Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario
| | - Ida-Maisie Famiyeh
- Clinical pharmacist at Bruyère Continuing Care in Ottawa and a first-year medical student at the University of Toronto in Ontario
| | - Matthew Preteroti
- Research assistant at the Bruyère Research Institute and is a first-year medical student at the Royal College of Surgeons in Ireland School of Medicine in Dublin
| | - Vincent Vuong
- Pharmacist research assistant at Trillium Health Partners in Mississauga, Ont
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Farrell B. Dix années de travaux liés aux guides de pratique clinique sur la déprescription. Can Fam Physician 2023; 69:671-674. [PMID: 37833078 PMCID: PMC10575663 DOI: 10.46747/cfp.6910671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Affiliation(s)
- Barbara Farrell
- Scientifique principale à l’Institut de recherche Bruyère à Ottawa (Ontario); professeure adjointe au Département de médecine familiale de l’Université d’Ottawa; et professeure adjointe auxiliaire à l’École de pharmacie de l’Université de Waterloo (Ontario)
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Thompson W, McCarthy LM, Galley E, Homan L, Farrell B. Using Shared Decision-Making Resources in Long-Term Care: a Qualitative Study. Can Geriatr J 2023; 26:253-258. [PMID: 37265981 PMCID: PMC10198683 DOI: 10.5770/cgj.26.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background Shared decision-making (SDM) incorporates people's individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that are a good fit for them as individuals. Methods We conducted a pilot study to understand experiences of two LTC homes in Ontario as they tested implementing SDM resources to support medication decisions. LTC homes conducted two Plan-Do-Study-Act (PDSA) cycles supported by an Advisory Group composed of LTC home representatives and stakeholders involved in resource design. Rapid qualitative analysis of transcripts and field notes from Advisory Group meetings elucidated how SDM resources were used. Results Each site was positively engaged but implemented resources differently. The pharmacist and physicians at Site 1 introduced proton-pump inhibitor (PPI) deprescribing as their primary intervention, identifying suitable residents, informing residents and families of the deprescribing process, and providing selected SDM resources to residents, caregivers and staff. Representatives reported limited engagement with SDM resources and difficulty measuring the impact of PPI deprescribing. Representatives from Site 2 disseminated the SDM resources to residents and caregivers for use at care conferences and focused on front-line staff education and involvement. This site reported that some residents/caregivers were interested in participating in SDM and using the resources, while others were not. The impact of the resources on SDM at this site was unclear. Conclusions Within the context of LTC, further research is needed to clarify the meaning and importance of SDM in medication decision-making. Implementation of SDM will likely require a multi-faceted approach.
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Affiliation(s)
- Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Lisa M. McCarthy
- Institute for Better Health, Trillium Health Partners, Mississauga, ON
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
- Bruyère Research Institute, Ottawa, ON
- Women’s College Research Institute, Toronto, ON
- School of Pharmacy, University of Waterloo, Waterloo, ON
| | - Emily Galley
- Bruyère Research Institute, Ottawa, ON
- School of Public Policy, University of Calgary, Calgary, AB
| | | | - Barbara Farrell
- Bruyère Research Institute, Ottawa, ON
- School of Pharmacy, University of Waterloo, Waterloo, ON
- Department of Family Medicine, University of Ottawa, Ottawa, ON
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Mangin D, Lamarche L, Agarwal G, Ali A, Cassels A, Colwill K, Dolovich L, Brown ND, Farrell B, Freeman K, Frizzle K, Garrison SR, Gillett J, Holbrook A, Jurcic-Vrataric J, McCormack J, Parascandalo J, Richardson J, Risdon C, Sherifali D, Siu H, Borhan S, Templeton JA, Thabane L, Trimble J. Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy. Pilot Feasibility Stud 2023; 9:84. [PMID: 37202822 DOI: 10.1186/s40814-023-01315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Polypharmacy is associated with poorer health outcomes in older adults. Other than the associated multimorbidity, factors contributing to this association could include medication adverse effects and interactions, difficulties in managing complicated medication regimes, and reduced medication adherence. It is unknown how reversible these negative associations may be if polypharmacy is reduced. The purpose of this study was to determine the feasibility of implementing an operationalized clinical pathway aimed to reduce polypharmacy in primary care and to pilot measurement tools suitable for assessing change in health outcomes in a larger randomized controlled trial (RCT). METHODS We randomized consenting patients ≥ 70 years old on ≥ 5 long-term medications into intervention or control groups. We collected baseline demographic information and research outcome measures at baseline and 6 months. We assessed four categories of feasibility outcomes: process, resource, management, and scientific. The intervention group received TAPER (team approach to polypharmacy evaluation and reduction), a clinical pathway for reducing polypharmacy using "pause and monitor" drug holiday approach. TAPER integrates patients' goals, priorities, and preferences with an evidence-based "machine screen" to identify potentially problematic medications and support a tapering and monitoring process, all supported by a web-based system, TaperMD. Patients met with a clinical pharmacist and then with their family physician to finalize a plan for optimization of medications using TaperMD. The control group received usual care and were offered TAPER after follow-up at 6 months. RESULTS All 9 criteria for feasibility were met across the 4 feasibility outcome domains. Of 85 patients screened for eligibility, 39 eligible patients were recruited and randomized; two were excluded post hoc for not meeting the age requirement. Withdrawals (2) and losses to follow-up (3) were small and evenly distributed between arms. Areas for intervention and research process improvement were identified. In general, outcome measures performed well and appeared suitable for assessing change in a larger RCT. CONCLUSIONS Results from this feasibility study indicate that TAPER as a clinical pathway is feasible to implement in a primary care team setting and in an RCT research framework. Outcome trends suggest effectiveness. A large-scale RCT will be conducted to investigate the effectiveness of TAPER on reducing polypharmacy and improving health outcomes. TRIAL REGISTRATION clinicaltrials.gov NCT02562352 , Registered September 29, 2015.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
- Dept. of General Practice, University of Otago, Christchurch, New Zealand.
| | - Larkin Lamarche
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Gina Agarwal
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Abbas Ali
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Alan Cassels
- University of Victoria, 3800 Finnerty Rd, Victoria, BC, Canada
| | - Kiska Colwill
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
- University of Toronto, 144 College Street, Toronto, ON, Canada
| | - Naomi Dore Brown
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Barbara Farrell
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, Canada
| | - Karla Freeman
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Kristina Frizzle
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Scott R Garrison
- University of Alberta, 6-60 University Terrace, Edmonton, AB, Canada
| | - James Gillett
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Anne Holbrook
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Jane Jurcic-Vrataric
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - James McCormack
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada
| | - Jenna Parascandalo
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Julie Richardson
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Cathy Risdon
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Diana Sherifali
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Henry Siu
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Sayem Borhan
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Jeffery A Templeton
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Lehana Thabane
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Johanna Trimble
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, Canada
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Mangin D, Lamarche L, Freeman K, Ali A, Clark R, Shah N, Awan A, Langevin J, Parascandalo J, Dore Brown N, Jurcic-Vrataric J, Colwill K, Dragos S, Borhan S, Risdon C, Siu H, Farrell B, Trimble J. Linking Patients' Goals and Priorities to Recommendations for Medication Changes in a Polypharmacy-Focused Structured Clinical Pathway. J Patient Exp 2023; 10:23743735231174762. [PMID: 37213440 PMCID: PMC10196540 DOI: 10.1177/23743735231174762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Polypharmacy is associated with poorer health outcomes in older adults. It is challenging to minimize the harmful effects of medications while maximizing benefits of single-disease-focused recommendations. Integrating patient input can balance these factors. The objectives are to describe the goals, priorities, and preferences of participants asked about these in a structured process to polypharmacy, and to describe the extent that decision-making within the process mapped onto these, signaling a patient-centered approach. This is a single-group quasi-experimental study, nested within a feasibility randomized controlled trial. Patient goals and priorities were mapped to medication recommendations made during the intervention. Overall, there were 33 participants who reported 55 functional goals and 66 symptom priorities, and 16 participants reported unwanted medications. Overall, 154 recommendations for medication alterations occurred. Of those, 68 (44%) recommendations mapped to the individual's goals and priorities, whereas the rest were based on clinical judgment where no priorities were expressed. Our results signal this process supports a patient-centered approach: allowing conversations around goals and priorities in a structured process to polypharmacy should be integrated into subsequent medication decisions.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karla Freeman
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Abbas Ali
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Clark
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nikki Shah
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amen Awan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Langevin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jenna Parascandalo
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Naomi Dore Brown
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kiska Colwill
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven Dragos
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sayem Borhan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Henry Siu
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Barbara Farrell
- Department of Family Medicine, Bruyère
Research Institute, Ottawa, Ontario, Canada
| | - Johanna Trimble
- Patient Voices Network, BC Patient Safety and Quality
Council, Vancouver, British Columbia, Canada
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Farrell B, Raman-Wilms L, Sadowski CA, Mallery L, Turner J, Gagnon C, Cole M, Grill A, Isenor JE, Mangin D, McCarthy LM, Schuster B, Sirois C, Sun W, Upshur R. A Proposed Curricular Framework for an Interprofessional Approach to Deprescribing. Med Sci Educ 2023; 33:551-567. [PMID: 37261023 PMCID: PMC10226933 DOI: 10.1007/s40670-022-01704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/02/2023]
Abstract
Deprescribing involves reducing or stopping medications that are causing more harm than good or are no longer needed. It is an important approach to managing polypharmacy, yet healthcare professionals identify many barriers. We present a proposed pre-licensure competency framework that describes essential knowledge, teaching strategies, and assessment protocols to promote interprofessional deprescribing skills. The framework considers how to involve patients and care partners in deprescribing decisions. An action plan and example curriculum mapping exercise are included to help educators assess their curricula, and select and implement these concepts and strategies within their programs to ensure learners graduate with competencies to manage increasingly complex medication regimens as people age. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01704-9.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8 Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON Canada
| | - Lalitha Raman-Wilms
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- Centre On Aging, Winnipeg, MB Canada
| | - Cheryl A. Sadowski
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB Canada
| | - Laurie Mallery
- Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Justin Turner
- Faculty of Pharmacy, University of Montreal, Montreal, QC Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC Canada
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| | - Camille Gagnon
- Canadian Deprescribing Network, Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC Canada
| | - Mollie Cole
- Canadian Gerontological Nursing Association, Calgary, AB Canada
| | - Allan Grill
- Dept. of Family & Community Medicine, University of Toronto, Toronto, ON Canada
- Markham Family Health Team, Markham, ON Canada
- Ontario Renal Network, Toronto, Canada
| | - Jennifer E. Isenor
- College of Pharmacy, Faculty of Health and Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Dee Mangin
- David Braley & Nancy Gordon Chair in Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON Canada
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Lisa M. McCarthy
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8 Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON Canada
- Institute for Better Health and Pharmacy Department, Trillium Health Partners, Mississauga, ON Canada
- Leslie Dan Faculty of Pharmacy & Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
- Women’s College Research Institute, Toronto, ON Canada
| | - Brenda Schuster
- College of Medicine (Regina Campus), University of Saskatchewan, Regina, Saskachewan Canada
| | - Caroline Sirois
- Centre d’excellence Sur Le Vieillissement de Québec & VITAM - Research Centre On Sustainable Health, Québec, Canada
- Faculty of Pharmacy, Université Laval, Québec, Canada
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Bridgepoint Collaboratory for Research and Innovation, Toronto, ON Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, ON Canada
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Farrell B, Rousse-Grossman J, Santamaria C, McCarthy LM. Applying the Behaviour Change Wheel to support deprescribing in long-term care: Qualitative interviews with stakeholder participants. Exploratory Research in Clinical and Social Pharmacy 2023; 9:100256. [PMID: 37091629 PMCID: PMC10113898 DOI: 10.1016/j.rcsop.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Background Implementation and behavioural science are increasingly being used to support development and translation of evidence-based interventions into practice. We used the Behaviour Change Wheel (BCW) approach in two stakeholder forums to identify target behaviours and supporting actions to inform the development of a framework to support deprescribing in long-term care homes. During our planning for these forums, we found many applications of the BCW approach used in healthcare. However, we found no accounts of stakeholders' experiences when the BCW approach was used with large groups of people who were mostly unfamiliar with behavioural science. Objective The goal of this research was to gain insight into the use of the BCW approach in the context of developing a framework to support deprescribing in long-term care. Methods This descriptive qualitative study employed one-on-one semi-structured interviews with Ontario long-term care stakeholders who had participated in one or both of two in-person forums that we hosted. Interviews were transcribed verbatim and an inductive content-analysis approach was used to code data and determine themes. Results Fifteen interviews were conducted. Four themes were identified. First, the BCW was new and made sense, but people found it hard to identify target behaviours before planning solutions. Second, participants varied in their opinions as to whether the 'right' people were participating. Third, participants found that the forum activities, worksheets and facilitators helped people use the approach. Fourth, stakeholder perspectives about potential implementation challenges and strategies to maximize success were identified. Conclusions Overall, participants were positive about the use of the BCW approach, however, its usefulness could be optimized by enhancing explanations, facilitation and logistics to ensure an initial focus on targeting behaviours. Making stakeholder perspectives transparent and ensuring mechanisms are present to ensure all views are sought and considered are also important to optimizing participant experience.
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Farrell B. Measuring the usefulness and impact of “Talking about Medications” workshops. Can Pharm J (Ott) 2023; 156:54. [PMID: 36969307 PMCID: PMC10034528 DOI: 10.1177/17151635231153382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 02/18/2023]
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Conklin J, Farrell B, Dilliott D, Richardson L, McCarthy L, Raman-Wilms L. Community engagement in a disengaged world: Developing and implementing educational workshops on deprescribing amid the COVID-19 pandemic. Can Pharm J (Ott) 2022; 156:8-13. [PMID: 36660418 PMCID: PMC9742724 DOI: 10.1177/17151635221139830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/21/2022] [Indexed: 12/13/2022]
Affiliation(s)
| | - Barbara Farrell
- Bruyère Research Institute, Ottawa,
Ontario,Department of Family Medicine,
University of Ottawa
| | | | | | - Lisa McCarthy
- Bruyère Research Institute, Ottawa,
Ontario,Institute for Better Health, Trillium
Health Partners, Mississauga,Leslie Dan Faculty of Pharmacy and
Department of Family and Community Medicine, University of
Toronto, Toronto, Ontario
| | - Lalitha Raman-Wilms
- College of Pharmacy, Rady Faculty of
Health Sciences, University of Manitoba, Winnipeg,
Manitoba
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Farrell B, Grant RE, Dilliott D, Granikov V, Sen HE, Grad R, Vuong V, Smith S, Pluye P. Lessons learned from using whiteboard videos and YouTube for deprescribing guidelines knowledge mobilization. Int J Pharm Pract 2022; 30:441-448. [PMID: 35849347 DOI: 10.1093/ijpp/riac054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Deprescribing is the planned and supervised process of dose reduction or stopping medication. Few clinical guidelines exist to help health care professionals in making decisions about deprescribing. The Bruyère Deprescribing Guidelines Team developed a series of evidence-based medication-class specific deprescribing guidelines and, to extend reach and uptake, disseminated them as whiteboard videos published on YouTube. This paper reports on the creation, sharing and evaluation of videos on proton pump inhibitor (PPI), antihyperglycemic (AHG), antipsychotic (AP) and benzodiazepine receptor agonist (BZRA) deprescribing guidelines. METHODS Whiteboard videos depict an animator drawing on a whiteboard, while the narrator reads the script. In each video, the deprescribing algorithm is applied to mock patient cases. The videos were shared on YouTube and promoted via Twitter and other web-based tools. Evaluation methods included YouTube analytics and the validated Information Assessment Method (IAM) questionnaire. KEY FINDINGS The four videos have a combined total of 26 387 views over the approximately 50 months since publishing, with viewers watching 34-40% of the videos' runtimes on average. The PPI and AHG deprescribing videos were viewed 4318 times in 97 countries during the first year. IAM respondents perceived the PPI, AHG and AP video content to be relevant, useful to learning and applicable to patient care. CONCLUSIONS Using whiteboard videos on YouTube to explain deprescribing guidelines was a successful approach to knowledge mobilization. The evaluation approach is innovative as it combines typical success factors for online learning videos (e.g. views, estimated minutes watched) with responses to a validated information assessment tool.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rachel E Grant
- Bruyère Research Institute, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Dilliott
- Bruyère Research Institute, Ottawa, ON, Canada
- Queen's University School of Medicine, Kingston, ON, Canada
| | - Vera Granikov
- School of Information Studies, McGill University, Montréal, QC, Canada
| | - Heera Elize Sen
- Bruyère Research Institute, Ottawa, ON, Canada
- Peter A. Allard School of Law, University of British Columbia, Vancouver, BC, Canada
| | - Roland Grad
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | | | - Pierre Pluye
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Elliot Lass
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Baycrest Health Sciences, Toronto, ON, Canada
- Granovsky-Gluskin Family Medicine Centre, Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, ON, Canada
| | - Paul Moayyedi
- McMaster University Medical Centre, Hamilton, ON, Canada
| | | | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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Affiliation(s)
- Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyNSWAustralia
| | | | - Dina Muscat Meng
- Cochrane Sustainable HealthcareCochrane Sweden and Cochrane Denmark, Cochrane
| | - Barbara Farrell
- Bruyere Research Institute, Ottawa and Department of Family MedicineUniversity of OttawaOttawaCanada
| | - Aili Langford
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyNSWAustralia
| | - Emily Reeve
- Clinical and Health SciencesUniversity of South AustraliaSAAustralia
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McCarthy LM, Farrell B, Howell P, Quast T. Supporting deprescribing in long-term care: An approach using stakeholder engagement, behavioural science and implementation planning. Exploratory Research in Clinical and Social Pharmacy 2022; 7:100168. [PMID: 36045709 PMCID: PMC9420956 DOI: 10.1016/j.rcsop.2022.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/17/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Approaches for optimizing medication use and enhancing medication experiences, including deprescribing, for older people living in long-term care homes are urgently needed. Through a multiphase initiative involving an environmental scan (2018) and two stakeholder forums (2019, 2020), we created a framework for developing and implementing sustainable deprescribing practices in this sector. Representatives from public advocacy, health care professionals, long-term care, pharmacy service providers, and regional health and public policy organizations in Ontario, Canada were consulted. We used behavioural science and implementation planning strategies to develop four target behaviours and 14 supporting actions; five of these actions were prioritized for further work. Throughout the phases, stakeholders committed to participation at various levels including ongoing implementation teams working to develop resources for the prioritized actions. A key element of success was attracting and sustaining engagement of a wide variety of relevant stakeholders from across the health system by leveraging best practices in stakeholder engagement. The approach used is described in detail so that it can be adapted and applied by others to plan large behaviour change initiatives.
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Farrell B, Galley E, Jeffs L, Howell P, McCarthy LM. “Kind of blurry”: Deciphering clues to prevent, investigate and manage prescribing cascades. PLoS One 2022; 17:e0272418. [PMID: 36044402 PMCID: PMC9432713 DOI: 10.1371/journal.pone.0272418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background Prescribing cascades, where a medication is used to treat the side effect of another medication, contribute to polypharmacy and related morbidity. Little is known about clinicians’ and patients’ experiences with prescribing cascades. In this study, we explored why and how prescribing cascades occur across a variety of care settings and how they are managed. Methods and findings This descriptive qualitative study employed semi-structured interviews with older adults who may have experienced a prescribing cascade(s), their caregivers, and healthcare providers. Interviewees were recruited through physician referral from a Geriatric Day Hospital, two long-term care homes in Ottawa, Ontario, and through self-referral across Ontario, Canada. An inductive approach was used to code data and determine themes. Thirty-one interviews were conducted for ten unique patient cases. Some interviewees were involved in more than one case, resulting in 22 unique interviewees. Three themes were identified. First, recognition of prescribing cascades is linked to awareness of medication side effects. Second, investigation and management of prescribing cascades is simultaneous and iterative (rather than linear and sequential). Third, prevention of prescribing cascades requires intentional strategies to help people anticipate and recognize medication side effects. Difficulty with recruitment from both long-term care homes and through self-referral was the central limitation. This exemplifies challenges associated with studying a poorly recognized and underexplored phenomenon. Conclusions In order to better recognize, investigate and manage prescribing cascades, clinicians and patients need to know more about medication side effects; they need to ask ‘can this be caused by a drug?’ when signs and symptoms arise or worsen; and they need access to information about medication experiences to have benefit-risk discussions and make decisions about deprescribing. Approaches for raising public awareness of prescribing cascades should be trialed to raise the profile of this issue and facilitate continued exploration of the phenomenon.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Emily Galley
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Pam Howell
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Lisa M. McCarthy
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Leslie Dan Faculty of Pharmacy and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
- * E-mail:
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Farrell B, Dilliott D, Richardson L, Conklin J, McCarthy LM, Raman-Wilms L. “Talking About Your Medications”: A workshop series aimed at helping older adults participate in conversations about their medications. Can Pharm J (Ott) 2022; 155:86-92. [PMID: 35300023 PMCID: PMC8922225 DOI: 10.1177/17151635221076075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, Ottawa, Ontario
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
| | | | | | - James Conklin
- Bruyère Research Institute, Ottawa, Ontario
- Concordia University, Montreal, Quebec
| | - Lisa M. McCarthy
- Bruyère Research Institute, Ottawa, Ontario
- Leslie Dan Faculty of Pharmacy and Department of Family and Community Medicine
| | - Lalitha Raman-Wilms
- University of Toronto, Toronto, Ontario; and the College of Pharmacy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Tremblay Z, Mumbere D, Laurin D, Sirois C, Furrer D, Poisblaud L, Carmichael PH, Farrell B, Tourigny A, Giguere A, Vedel I, Morais J, Kröger E. Health Impacts and Characteristics of Deprescribing Interventions in Older Adults: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2021; 10:e25200. [PMID: 34889771 PMCID: PMC8704115 DOI: 10.2196/25200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 08/05/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022] Open
Abstract
Background Deprescribing, a relatively recent concept, has been proposed as a promising solution to the growing issues of polypharmacy and use of medications of questionable benefit among older adults. However, little is known about the health outcomes of deprescribing interventions. Objective This paper presents the protocol of a study that aims to contribute to the knowledge on deprescribing by addressing two specific objectives: (1) describe the impact of deprescribing in adults ≥60 years on health outcomes or quality of life; and (2) determine the characteristics of effective interventions in deprescribing. Methods Primary studies targeting three concepts (older adults, deprescribing, and health or quality of life outcomes) will be included in the review. The search will be performed using key international databases (MEDLINE, EMBASE, CINAHL, Ageline, PsycInfo), and a special effort will be made to identify gray literature. Two reviewers will independently screen the articles, extract the information, and evaluate the quality of the selected studies. If methodologically feasible, meta-analyses will be performed for groups of intervention studies reporting on deprescribing interventions for similar medications, used for similar or identical indications, and reporting on similar outcomes (eg, benzodiazepines used against insomnia and studies reporting on quality of sleep or quality of life). Alternatively, the results will be presented in bottom-line statements (objective 1) and a matrix outlining effective interventions (objective 2). Results The knowledge synthesis may be limited by the availability of high-quality clinical trials on deprescribing and their outcomes in older adults. Additionally, analyses will likely be affected by studies on the deprescribing of different types of molecules within the same indication (eg, different pharmacological classes and medications to treat hypertension) and different measures of health and quality of life outcomes for the same indication. Nevertheless, we expect the review to identify which deprescribing interventions lead to improved health outcomes among seniors and which of their characteristics contribute to these outcomes. Conclusions This systematic review will contribute to a better understanding of the health outcomes of deprescribing interventions among seniors. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42015020866; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015020866 International Registered Report Identifier (IRRID) PRR1-10.2196/25200
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Affiliation(s)
- Zoë Tremblay
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | - David Mumbere
- Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | | | | | - Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Lise Poisblaud
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada
| | - Barbara Farrell
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - André Tourigny
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Anik Giguere
- Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Isabelle Vedel
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - José Morais
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Edeltraut Kröger
- Faculté de pharmacie, Université Laval, Québec, QC, Canada.,Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale, Québec, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
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Mangin D, Lamarche L, Agarwal G, Banh HL, Dore Brown N, Cassels A, Colwill K, Dolovich L, Farrell B, Garrison S, Gillett J, Griffith LE, Holbrook A, Jurcic-Vrataric J, McCormack J, O’Reilly D, Raina P, Richardson J, Risdon C, Savelli M, Sherifali D, Siu H, Tarride JÉ, Trimble J, Ali A, Freeman K, Langevin J, Parascandalo J, Templeton JA, Dragos S, Borhan S, Thabane L. Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial. Trials 2021; 22:746. [PMID: 34702336 PMCID: PMC8549321 DOI: 10.1186/s13063-021-05685-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/05/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient's priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults. METHODS We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. DISCUSSION Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient's goals and priorities for treatment. TRIAL REGISTRATION Clinical Trials.gov NCT02942927. First registered on October 24, 2016.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Hoan Linh Banh
- University of Alberta, 6-60 University Terrace, Edmonton, Alberta Canada
| | - Naomi Dore Brown
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Alan Cassels
- University of Victoria, 3800 Finnerty Road, Victoria, BC Canada
| | - Kiska Colwill
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
- University of Toronto, 144 College Street, Toronto, Ontario Canada
| | - Barbara Farrell
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario Canada
| | - Scott Garrison
- University of Alberta, 6-60 University Terrace, Edmonton, Alberta Canada
| | - James Gillett
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Lauren E. Griffith
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Anne Holbrook
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jane Jurcic-Vrataric
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - James McCormack
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada
| | - Daria O’Reilly
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Parminder Raina
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Julie Richardson
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Mat Savelli
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Diana Sherifali
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Henry Siu
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jean-Éric Tarride
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Johanna Trimble
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC Canada
| | - Abbas Ali
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Karla Freeman
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jessica Langevin
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jenna Parascandalo
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Jeffrey A. Templeton
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Steven Dragos
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Sayem Borhan
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Lehana Thabane
- Department of Family Medicine, McMaster University, 100 Main Street West., 5th floor, Hamilton, Ontario L8P 1H6 Canada
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Abstract
Introduction We developed a new channel on a mobile app as a continuing education tool to augment the use of deprescribing guideline content in clinical practice. In this research brief, we describe the reach and adoption of channel content, as well as user feedback. Methods Using Google Analytics, we counted page views of the website (deprescribing.org) where the app was promoted. We calculated total app downloads, monthly active users, and guideline-specific page views. Users were invited to complete the embedded Information Assessment Method (IAM) Questionnaire to obtain feedback on the value of information presented on the Deprescribing Channel. Results Between March 2, 2019 and November 30, 2019, we documented 9,454 page views of the promotional web page across 40 countries. The Deprescribing Channel was downloaded 3,256 times with an average of 464 monthly users. In total, the guidelines on this channel were accessed 14,377 times with 49,721 views across all guideline pages. Thirty-seven IAM questionnaires were completed. Thirty-two responses indicated this deprescribing information was relevant for at least one of their patients. Regarding educational outcomes, 22 responses were of learning something new and/or being motivated to learn more. Conclusion We documented international interest in a mobile app providing continuing education on deprescribing. App users generated sustained page views over the study period. Feedback from a small number of users was positive with the majority finding the content relevant, educational, and applicable to patient care. Further work is needed to improve the usability of the embedded feedback questionnaire and to evaluate its value in supporting learning.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute and Department of Family Medicine, University of Ottawa, Ottawa, Canada
- and School of Pharmacy, University of Waterloo, Waterloo, Canada
| | - Roland Grad
- McGill University Department of Family Medicine, Montreal, Quebec, Canada
| | - Pam Howell
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Tammie Quast
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
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Mitchell E, Goodman K, Hartley S, Hickey H, McDonald AM, Meadows HM, Rhodes S, Taylor J, Wakefield N, Farrell B. Where do we go from here? - Opportunities and barriers to the career development of trial managers: a survey of UK-based trial management professionals. Trials 2020; 21:384. [PMID: 32375851 PMCID: PMC7203789 DOI: 10.1186/s13063-020-04316-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Clinical trials commonly have a dedicated trial manager and effective trial management is essential to the successful delivery of high-quality trials. Trial managers have diverse experience and currently there is no standardised structured career pathway. The UK Trial Managers’ Network (UKTMN) surveyed its members to understand what is important to them with respect to career development since this would be important in the development of any initiative intended to develop a skilled workforce. Methods We conducted an online survey of UKTMN members, who are trial management professionals, working on academic-led trials in the UK. Members were asked what they perceive as opportunities and barriers to career development. Two reminders were sent to facilitate completion of the survey, and responders were offered the opportunity to enter a prize draw for waived fees at the UKTMN annual meeting. Data were analysed descriptively by using Stata (version 15.1), and free-text responses were reviewed for themes. Results The survey was sent to 819 UKTMN members; 433 responses were received, although 13 were from non-UKTMN members; thus 420 respondents' data were included in analyses. Respondents were representative of UKTMN membership; however, more responses were received by trial managers based in registered clinical trials units (CTUs). The top three opportunities for career development were (i) training, (ii) helping design trials and (iii) undertaking relevant qualifications. The top three barriers were (i) funding, (ii) few opportunities to get involved in development activities aside from managing a trial and (iii) unclear organisational career pathway. Almost all respondents (401/420, 95.4%) considered career development either very or quite important. Although all respondents had a day-to-day role in managing trials, there was huge disparity between job titles. Conclusion Career development is important to trial managers yet there is a lack of a structured pathway. The enablers and disablers to career development for trial managers should be clearly considered by the clinical trial community and, in particular, employers, sponsors and funders in order to develop a highly skilled workforce of trial managers, who are key to the delivery of trials.
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Affiliation(s)
- Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Helen Hickey
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, L69 3BX, UK
| | - Alison M McDonald
- Centre for Healthcare Randomised Trials (CHaRT) Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Helen M Meadows
- Cancer Research UK & UCL Cancer Trials Centre & Institute of Clinical Trials & Methodology, UCL, 90 Tottenham Court Rd, London, UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit (ExeCTU), University of Exeter, St Luke's Campus, Exeter, Devon, EX1 2LU, UK
| | - Jodi Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Natalie Wakefield
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Barbara Farrell
- National Perinatal Epidemiology Unit, Clinical Trials Unit, University of Oxford, Richard Doll Building, Headington, Oxford, OX3 7LF, UK
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Farrell B, Clarkin C, Conklin J, Dolovich L, Irving H, McCarthy L, Raman-Wilms L. Community pharmacists as catalysts for deprescribing: An exploratory study using quality improvement processes. Can Pharm J (Ott) 2019; 153:37-45. [PMID: 32002101 DOI: 10.1177/1715163519882969] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is growing international emphasis on deprescribing, involving the monitored reduction or stopping of medications that are no longer needed or that cause more harm than benefits, especially for the elderly. Community pharmacists are well positioned to partner with patients and their other health care providers in facilitating deprescribing activities. Objective To build community pharmacists' capacity to integrate deprescribing into their daily practices through training and workflow strategies. Methods This study used an exploratory mixed-methods (primarily qualitative) design. Staff at 4 Ontario pharmacies were trained to use deprescribing guidelines. Qualitative data were collected through field observations, notes from advisory group meetings and documented Plan-Do-Study-Act (PDSA) plans. Quantitative data were derived from process and output measures reported by the pharmacies. Iterative PDSA cycles allowed the project team to appraise and accelerate process improvements over time and to summarize findings on facilitators, barriers and the adaptation of processes. Results All 4 pharmacies identified individual and common goals related to deprescribing; however, drugs targeted and use of professional services to identify and address deprescribing opportunities varied. Each demonstrated that deprescribing activities could be integrated into daily practice and workflow. Common themes characterized approaches taken by each pharmacy: (1) processes used for capacity building among staff to identify patients for possible deprescribing, (2) approaches for preliminary interactions with patients, (3) in-depth medication reviews and (4) follow-up and monitoring. Approaches changed over time. Conclusion Deprescribing appears to be feasible in community pharmacies. Data derived to populate a business model canvas informs the development of an in-depth business model for deprescribing. Can Pharm J (Ott) 2019;152:xx-xx.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute (Farrell, Clarkin, Conklin, Irving), University of Ottawa, Ottawa.,Department of Family Medicine (Farrell), University of Ottawa, Ottawa.,School of Pharmacy (Farrell), University of Waterloo, Waterloo.,Leslie Dan Faculty of Pharmacy (Dolovich, McCarthy, Raman-Wilms), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,Women's College Research Institute (McCarthy), Toronto.,Department of Family Medicine (Dolovich), McMaster University, Hamilton, Ontario.,College of Pharmacy (Raman-Wilms), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Chantalle Clarkin
- Bruyère Research Institute (Farrell, Clarkin, Conklin, Irving), University of Ottawa, Ottawa.,Department of Family Medicine (Farrell), University of Ottawa, Ottawa.,School of Pharmacy (Farrell), University of Waterloo, Waterloo.,Leslie Dan Faculty of Pharmacy (Dolovich, McCarthy, Raman-Wilms), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,Women's College Research Institute (McCarthy), Toronto.,Department of Family Medicine (Dolovich), McMaster University, Hamilton, Ontario.,College of Pharmacy (Raman-Wilms), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - James Conklin
- Bruyère Research Institute (Farrell, Clarkin, Conklin, Irving), University of Ottawa, Ottawa.,Department of Family Medicine (Farrell), University of Ottawa, Ottawa.,School of Pharmacy (Farrell), University of Waterloo, Waterloo.,Leslie Dan Faculty of Pharmacy (Dolovich, McCarthy, Raman-Wilms), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,Women's College Research Institute (McCarthy), Toronto.,Department of Family Medicine (Dolovich), McMaster University, Hamilton, Ontario.,College of Pharmacy (Raman-Wilms), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Lisa Dolovich
- Bruyère Research Institute (Farrell, Clarkin, Conklin, Irving), University of Ottawa, Ottawa.,Department of Family Medicine (Farrell), University of Ottawa, Ottawa.,School of Pharmacy (Farrell), University of Waterloo, Waterloo.,Leslie Dan Faculty of Pharmacy (Dolovich, McCarthy, Raman-Wilms), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,Women's College Research Institute (McCarthy), Toronto.,Department of Family Medicine (Dolovich), McMaster University, Hamilton, Ontario.,College of Pharmacy (Raman-Wilms), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Hannah Irving
- Bruyère Research Institute (Farrell, Clarkin, Conklin, Irving), University of Ottawa, Ottawa.,Department of Family Medicine (Farrell), University of Ottawa, Ottawa.,School of Pharmacy (Farrell), University of Waterloo, Waterloo.,Leslie Dan Faculty of Pharmacy (Dolovich, McCarthy, Raman-Wilms), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,Women's College Research Institute (McCarthy), Toronto.,Department of Family Medicine (Dolovich), McMaster University, Hamilton, Ontario.,College of Pharmacy (Raman-Wilms), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Lisa McCarthy
- Bruyère Research Institute (Farrell, Clarkin, Conklin, Irving), University of Ottawa, Ottawa.,Department of Family Medicine (Farrell), University of Ottawa, Ottawa.,School of Pharmacy (Farrell), University of Waterloo, Waterloo.,Leslie Dan Faculty of Pharmacy (Dolovich, McCarthy, Raman-Wilms), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,Women's College Research Institute (McCarthy), Toronto.,Department of Family Medicine (Dolovich), McMaster University, Hamilton, Ontario.,College of Pharmacy (Raman-Wilms), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Lalitha Raman-Wilms
- Bruyère Research Institute (Farrell, Clarkin, Conklin, Irving), University of Ottawa, Ottawa.,Department of Family Medicine (Farrell), University of Ottawa, Ottawa.,School of Pharmacy (Farrell), University of Waterloo, Waterloo.,Leslie Dan Faculty of Pharmacy (Dolovich, McCarthy, Raman-Wilms), University of Toronto.,Department of Family and Community Medicine (McCarthy), University of Toronto.,Women's College Research Institute (McCarthy), Toronto.,Department of Family Medicine (Dolovich), McMaster University, Hamilton, Ontario.,College of Pharmacy (Raman-Wilms), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Ma A, Thompson W, Polemiti E, Hussain S, Magwood O, Welch V, Farrell B, Pottie K. Deprescribing of chronic benzodiazepine receptor agonists for insomnia in adults. Hippokratia 2019. [DOI: 10.1002/14651858.cd013371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Andy Ma
- The Ottawa Hospital; Pharmacy; Ottawa ON Canada
| | - Wade Thompson
- University of Ottawa; Bruyère Research Institute; 43 rue Bruyere St Room 730D Ottawa ON Canada K1N 5C8
| | - Elli Polemiti
- Bruyère Continuing Care; Bruyère Research Institute; 75 Bruyère St Ottawa ON Canada
| | - Sonia Hussain
- Bruyère Continuing Care; Medicine; 75 Bruyère St Ottawa ON Canada
| | - Olivia Magwood
- Bruyere Research Institute; C.T. Lamont Primary Health Care Research Centre; 85 Primrose Avenue Ottawa Ontario Canada
| | - Vivian Welch
- Bruyère Research Institute; Methods Centre; Ottawa ON Canada
| | - Barbara Farrell
- University of Ottawa; Bruyère Research Institute; 43 rue Bruyere St Room 730D Ottawa ON Canada K1N 5C8
| | - Kevin Pottie
- University of Ottawa; Family Medicine; 75 Bruyere St Ottawa ON Canada K1N 5C8
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Greiver M, Dahrouge S, O'Brien P, Manca D, Lussier MT, Wang J, Burge F, Grandy M, Singer A, Twohig M, Moineddin R, Kalia S, Aliarzadeh B, Ivers N, Garies S, Turner JP, Farrell B. Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada. Implement Sci 2019; 14:55. [PMID: 31171011 PMCID: PMC6551894 DOI: 10.1186/s13012-019-0904-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 01/17/2023] Open
Abstract
Background Elders living with polypharmacy may be taking medications that do not benefit them. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high care costs, and persistently complex care needs. While many medications could be problematic, this project targets medications that should be deprescribed for most elders and for which guidelines and evidence-based deprescribing tools are available. These are termed potentially inappropriate prescriptions (PIPs) and are as follows: proton pump inhibitors, benzodiazepines, antipsychotics, and sulfonylureas. Implementation strategies for deprescribing PIPs in complex older patient populations are needed. Methods This will be a pragmatic cluster randomized controlled trial in community-based primary care practices across Canada. Eligible practices provide comprehensive primary care and have at least one physician that consents to participate. Community-dwelling patients aged 65 years and older with ten or more unique medication prescriptions in the past year will be included. The objective is to assess whether the intervention reduces targeted PIPs for these patients compared with usual care. The intervention, Structured Process Informed by Data, Evidence and Research (SPIDER), is a collaboration between quality improvement (QI) and research programs. Primary care teams will form interprofessional Learning Collaboratives and work with QI coaches to review electronic medical record data provided by their regional Practice Based Research Networks (PBRNs), identify areas of improvement, and develop and implement changes. The study will be tested for feasibility in three PBRNs (Toronto, Montreal, and Edmonton) using prospective single-arm mixed methods. Findings will then guide a pragmatic cluster randomized controlled trial in five PBRNs (Calgary, Winnipeg, Ottawa, Montreal, and Halifax). Seven practices per PBRN will be recruited for each arm. The analysis will be by intention to treat. Ten percent of patients who have at least one PIP at baseline will be randomly selected to participate in the assessment of patient experience and self-reported outcomes. Qualitative methods will be used to explore patient and physician experience and evaluate SPIDER’s processes. Conclusion We are testing SPIDER in a primary care population with complex care needs. This could provide a widely applicable model for care improvement. Trial registration Clinicaltrials.gov NCT03689049; registered September 28, 2018 Electronic supplementary material The online version of this article (10.1186/s13012-019-0904-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Greiver
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada. .,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada.
| | - S Dahrouge
- Department of Family Medicine, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario, K1R 6M1, Canada.,Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, K1N 5C8, Canada
| | - P O'Brien
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - D Manca
- Department of Family Medicine, University of Alberta, 8303 - 112 Street NW, 610 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - M T Lussier
- Department of Family Medicine and Emergency Medicine, University of Montreal, 1755 René Laennec, Bureau DS-079, Laval, Québec, H7M3L9, Canada
| | - J Wang
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - F Burge
- Department of Family Medicine, Dalhousie University, 8F, 8525 Abbie J Lane Building, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada
| | - M Grandy
- Department of Family Medicine, Dalhousie University, 8F, 8525 Abbie J Lane Building, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada
| | - A Singer
- Department of Family Medicine, University of Manitoba, D009 - 780 Bannatyne Ave, Winnipeg, Manitoba, R3T 2N2, Canada
| | - M Twohig
- North York General Hospital, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - R Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada.,ICES, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - S Kalia
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - B Aliarzadeh
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 4001 Leslie Street, LE-140, Toronto, Ontario, M2K 1E1, Canada
| | - N Ivers
- Family Practice Health Centre and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5S 1B2, Canada
| | - S Garies
- Department of family Medicine, Cumming School of Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - J P Turner
- Faculty of Pharmacy, University of Montreal, 2900 Edouard Montpetit Boulevard, Montreal, Quebec, H3T 1J4, Canada.,Centre de Recherche, Institut Universitaire de Geriatrie de Montreal, Montreal, Canada
| | - B Farrell
- Department of Family Medicine, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario, K1R 6M1, Canada.,Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario, K1N 5C8, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Canada
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Raman-Wilms L, Farrell B, Sadowski C, Austin Z. Deprescribing: An educational imperative. Res Social Adm Pharm 2019; 15:790-795. [DOI: 10.1016/j.sapharm.2018.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
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Conklin J, Farrell B, Suleman S. Implementing deprescribing guidelines into frontline practice: Barriers and facilitators. Res Social Adm Pharm 2019; 15:796-800. [DOI: 10.1016/j.sapharm.2018.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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Affiliation(s)
- Barbara Farrell
- UK Trial Managers' Network, Nottingham Clinical Trials Unit, University of Nottingham, Nottingham NG7 2UH, UK.
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Reeve E, Farrell B, Thompson W, Herrmann N, Sketris I, Magin PJ, Chenoweth L, Gorman M, Quirke L, Bethune G, Hilmer SN. Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary. Med J Aust 2019; 210:174-179. [DOI: 10.5694/mja2.50015] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Emily Reeve
- NHMRC Cognitive Decline Partnership CentreKolling Institute of Medical ResearchNorthern Clinical SchoolUniversity of Sydney Sydney NSW
- Dalhousie University and Nova Scotia Health Authority Halifax Canada
| | - Barbara Farrell
- Bruyère Research Institute Ottawa Canada
- University of Ottawa Ottawa Canada
| | | | - Nathan Herrmann
- Sunnybrook Health Sciences Centre Toronto Canada
- University of Toronto Toronto Canada
| | | | - Parker J Magin
- University of Newcastle Newcastle NSW
- NSW and ACT Research and Evaluation UnitGP Synergy Regional Training Organisation Sydney NSW
| | - Lynn Chenoweth
- Centre for Healthy Brain AgeingUNSW Sydney NSW
- University of Notre Dame Sydney NSW
| | - Mary Gorman
- Dalhousie University Halifax Canada
- St Martha's Regional Hospital Antigonish Canada
| | - Lyntara Quirke
- Consumer NetworkAlzheimer's Australia Canberra ACT
- Dementia Training Australia
| | | | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership CentreKolling Institute of Medical ResearchNorthern Clinical SchoolUniversity of Sydney Sydney NSW
- Royal North Shore Hospital and University of Sydney Sydney NSW
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Farrell B, Mangin D. Deprescribing Is an Essential Part of Good Prescribing. Am Fam Physician 2019; 99:7-9. [PMID: 30600973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Dee Mangin
- McMaster University, Hamilton, Ontario, Canada
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Dolovich L, Austin Z, Waite N, Chang F, Farrell B, Grindrod K, Houle S, McCarthy L, MacCallum L, Sproule B. Pharmacy in the 21st century: Enhancing the impact of the profession of pharmacy on people's lives in the context of health care trends, evidence and policies. Can Pharm J (Ott) 2018; 152:45-53. [PMID: 30719197 DOI: 10.1177/1715163518815717] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Lisa Dolovich
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Nancy Waite
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Feng Chang
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Barbara Farrell
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Kelly Grindrod
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Sherilyn Houle
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
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Thompson W, Farrell B, Welch V, Tugwell P, Way C, Richardson L, Bjerre LM. Continuation or deprescribing of proton pump inhibitors: A consult patient decision aid. Can Pharm J (Ott) 2018; 152:18-22. [PMID: 30719193 DOI: 10.1177/1715163518816719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Wade Thompson
- School of Epidemiology, Public Health and Preventive Medicine (Thompson, Welch, Tugwell, Bjerre), University of Ottawa, Ottawa, Ontario.,Bruyère Research Institute (Thompson, Farrell, Welch, Tugwell, Bjerre), Ottawa, Ontario.,Department of Family Medicine (Farrell, Bjerre), University of Ottawa, Ottawa, Ontario.,Centre for Global Health (Welch, Tugwell), Ottawa, Ontario.,Ottawa Hospital Research Institute (Tugwell), Ottawa, Ontario.,Ottawa Hospital Academic Family Health Team (Way), Ottawa, Ontario.,Rideau Family Health Team (Richardson), Ottawa, Ontario, Ottawa, Ontario
| | - Barbara Farrell
- School of Epidemiology, Public Health and Preventive Medicine (Thompson, Welch, Tugwell, Bjerre), University of Ottawa, Ottawa, Ontario.,Bruyère Research Institute (Thompson, Farrell, Welch, Tugwell, Bjerre), Ottawa, Ontario.,Department of Family Medicine (Farrell, Bjerre), University of Ottawa, Ottawa, Ontario.,Centre for Global Health (Welch, Tugwell), Ottawa, Ontario.,Ottawa Hospital Research Institute (Tugwell), Ottawa, Ontario.,Ottawa Hospital Academic Family Health Team (Way), Ottawa, Ontario.,Rideau Family Health Team (Richardson), Ottawa, Ontario, Ottawa, Ontario
| | - Vivian Welch
- School of Epidemiology, Public Health and Preventive Medicine (Thompson, Welch, Tugwell, Bjerre), University of Ottawa, Ottawa, Ontario.,Bruyère Research Institute (Thompson, Farrell, Welch, Tugwell, Bjerre), Ottawa, Ontario.,Department of Family Medicine (Farrell, Bjerre), University of Ottawa, Ottawa, Ontario.,Centre for Global Health (Welch, Tugwell), Ottawa, Ontario.,Ottawa Hospital Research Institute (Tugwell), Ottawa, Ontario.,Ottawa Hospital Academic Family Health Team (Way), Ottawa, Ontario.,Rideau Family Health Team (Richardson), Ottawa, Ontario, Ottawa, Ontario
| | - Peter Tugwell
- School of Epidemiology, Public Health and Preventive Medicine (Thompson, Welch, Tugwell, Bjerre), University of Ottawa, Ottawa, Ontario.,Bruyère Research Institute (Thompson, Farrell, Welch, Tugwell, Bjerre), Ottawa, Ontario.,Department of Family Medicine (Farrell, Bjerre), University of Ottawa, Ottawa, Ontario.,Centre for Global Health (Welch, Tugwell), Ottawa, Ontario.,Ottawa Hospital Research Institute (Tugwell), Ottawa, Ontario.,Ottawa Hospital Academic Family Health Team (Way), Ottawa, Ontario.,Rideau Family Health Team (Richardson), Ottawa, Ontario, Ottawa, Ontario
| | - Cynthia Way
- School of Epidemiology, Public Health and Preventive Medicine (Thompson, Welch, Tugwell, Bjerre), University of Ottawa, Ottawa, Ontario.,Bruyère Research Institute (Thompson, Farrell, Welch, Tugwell, Bjerre), Ottawa, Ontario.,Department of Family Medicine (Farrell, Bjerre), University of Ottawa, Ottawa, Ontario.,Centre for Global Health (Welch, Tugwell), Ottawa, Ontario.,Ottawa Hospital Research Institute (Tugwell), Ottawa, Ontario.,Ottawa Hospital Academic Family Health Team (Way), Ottawa, Ontario.,Rideau Family Health Team (Richardson), Ottawa, Ontario, Ottawa, Ontario
| | - Lisa Richardson
- School of Epidemiology, Public Health and Preventive Medicine (Thompson, Welch, Tugwell, Bjerre), University of Ottawa, Ottawa, Ontario.,Bruyère Research Institute (Thompson, Farrell, Welch, Tugwell, Bjerre), Ottawa, Ontario.,Department of Family Medicine (Farrell, Bjerre), University of Ottawa, Ottawa, Ontario.,Centre for Global Health (Welch, Tugwell), Ottawa, Ontario.,Ottawa Hospital Research Institute (Tugwell), Ottawa, Ontario.,Ottawa Hospital Academic Family Health Team (Way), Ottawa, Ontario.,Rideau Family Health Team (Richardson), Ottawa, Ontario, Ottawa, Ontario
| | - Lise M Bjerre
- School of Epidemiology, Public Health and Preventive Medicine (Thompson, Welch, Tugwell, Bjerre), University of Ottawa, Ottawa, Ontario.,Bruyère Research Institute (Thompson, Farrell, Welch, Tugwell, Bjerre), Ottawa, Ontario.,Department of Family Medicine (Farrell, Bjerre), University of Ottawa, Ottawa, Ontario.,Centre for Global Health (Welch, Tugwell), Ottawa, Ontario.,Ottawa Hospital Research Institute (Tugwell), Ottawa, Ontario.,Ottawa Hospital Academic Family Health Team (Way), Ottawa, Ontario.,Rideau Family Health Team (Richardson), Ottawa, Ontario, Ottawa, Ontario
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Lee JY, Farrell B, Holbrook AM. Deprescribing benzodiazepine receptor agonists taken for insomnia: a review and key messages from practice guidelines. Pol Arch Intern Med 2018; 129:43-49. [PMID: 30543200 DOI: 10.20452/pamw.4391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Long‑term benzodiazepine receptor agonist (BZRA) use for insomnia is common and highly prevalent in adults in all care settings. Evidence syntheses suggest that the therapeutic benefits of benzodiazepines for insomnia are marginal and very short term. On the harm side, BZRAs are associated with daytime sedation and confusion. Long‑term use increases the risk of falls, fractures, cognitive impairment, and motor vehicle accidents. An evidence‑based clinical practice guideline has been developed to assist with deprescribing BZRAs. This review highlights the rationale for deprescribing BZRAs used for insomnia and summarizes key messages for clinicians from the new BZRA deprescribing guideline and their supporting evidence.
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Affiliation(s)
- Justin Y Lee
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada,Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada,Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Barbara Farrell
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada,School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne M Holbrook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada,Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Farrell B, Archibald D, Pizzola L, Ward N, Cho A, Tsang C. Impact on confidence and practice: How the ADAPT online patient care skills program made a difference for pharmacists. Res Social Adm Pharm 2018; 15:1251-1258. [PMID: 30448031 DOI: 10.1016/j.sapharm.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ADAPT "ADapting pharmacists' skills and Approaches to maximize Patients' drug Therapy effectiveness" online education program was developed to enable pharmacists to overcome a lack of confidence in patient care and collaborative skills, enabling successful adoption of expanded scope of pharmacist practice. OBJECTIVES This study examined responses of ADAPT participants, to determine if acquisition of knowledge, skill, and confidence is retained and translated into adoption of expanded scope of practice and billable services, perceived improvement in quality of patient care, and increased professional satisfaction. METHODS A sequential exploratory mixed methods approach was used for this study. RESULTS Fifty-four surveys were completed and 13 interviews were conducted. Greater than 86% agreed or strongly agreed that their confidence in their ability to perform ADAPT skills had improved. Billing for services varied based on province. Four themes emerged through the interview process: confidence, change, impact and barriers/facilitators. CONCLUSIONS Respondents described confidence in their ability to use ADAPT skills to make changes in personal practice activities, and this appeared to lead to taking on new roles that provided both professional satisfaction and improved patient care and professional relations. However, some barriers remained in providing or billing for certain practice activities.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario, N2G 1C5, Canada.
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
| | - Lisa Pizzola
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
| | - Natalie Ward
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada
| | - Ara Cho
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
| | - Corey Tsang
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario, N2G 1C5, Canada
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Farrell B, Thompson W, Black CD, Archibald D, Raman-Wilms L, Grassau P, Patel T, Weaver L, Eid K, Winslade N. Health care providers' roles and responsibilities in management of polypharmacy: Results of a modified Delphi. Can Pharm J (Ott) 2018; 151:395-407. [PMID: 30559915 PMCID: PMC6293398 DOI: 10.1177/1715163518804276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy. OBJECTIVES To identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy. METHODS Four focus groups with 35 team members practising in geriatrics were generated to inform survey development. The sessions generated 63 competencies, roles or responsibilities, which were categorized into 4 domains defined by the Canadian Interprofessional Health Collaborative. The resulting survey was administered nationally to geriatric health care professionals who were asked to rate the importance of each item in managing polypharmacy; we sought agreement within and across professions using a confirmatory 2-round Delphi method. RESULTS Round 1 was completed by 98 survey respondents and round 2 by 72. There was high intra-professional and interprofessional consensus regarding the importance of competencies among physicians, nurses and pharmacists; though pharmacists rated fewer competencies as important. Less consensus was observed among other health care professionals or they indicated the nonimportance of competencies despite focus group discussion to the contrary. DISCUSSION Although there is a strong consensus of polypharmacy management competencies across team members who have been more traditionally involved in medication management, there continue to be health care providers with differing understandings of competencies that may contribute to reduced reliance on medication. Lower importance ratings suggest pharmacists may not acknowledge or recognize their own potential roles in interprofessional polypharmacy management. CONCLUSION Further exploration to understand the underutilization of professional expertise in managing polypharmacy will contribute to refining role clarity and translating competencies in practical settings, as well as guiding educators regarding curricular content.
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Affiliation(s)
| | - Wade Thompson
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Cody D. Black
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Douglas Archibald
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Lalitha Raman-Wilms
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Pamela Grassau
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Tejal Patel
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Lynda Weaver
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Khaled Eid
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Nancy Winslade
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
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Turner JP, Richard C, Lussier MT, Lavoie ME, Farrell B, Roberge D, Tannenbaum C. Deprescribing conversations: a closer look at prescriber-patient communication. Ther Adv Drug Saf 2018; 9:687-698. [PMID: 30546863 DOI: 10.1177/2042098618804490] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background Little is known about the initiation, style and content of patient and healthcare provider communication around deprescribing. We report the findings from a content analysis of audio-recorded discussions of proton pump inhibitor (PPI) and benzodiazepine deprescribing in primary care. Methods Participants were healthcare providers (n = 13) from primary care practices (n = 3) and patients aged ⩾65 (n = 24) who were chronic users of PPIs or benzodiazepines. The EMPOWER educational brochures were distributed prior to (n = 15) or after (n = 9) the patient's usual healthcare provider appointment. Conversations were audio-recorded and coded using MEDICODE to analyze who initiated different themes, whether they followed a monologue or dialogue style, and to what extent the thematic content addressed issues pertaining to: 'dosage/instructions,' 'medication action and efficacy,' 'risk/adverse effects,' 'attitudes/emotions,' 'adherence' and 'follow up.' Descriptive analysis of the conversations was performed with comparison between patients who received the EMPOWER brochure before or after their appointments. Results Patients were mostly women (67%) with a mean age of 74 ± 6 years. For PPI users, prior education resulted in a greater proportion of themes initiated by patients (44% versus 17%) and maintaining dialogue-style conversations (48% versus 28%). Among benzodiazepine users, conversation initiation (52% versus 47%) and conversation style was similar between both groups. The content of deprescribing conversations for PPIs revealed that patients and their healthcare providers focused less on 'dosage/instructions,' and more on the 'medication action and efficacy' and the necessity for 'follow up.' Conversations about stopping benzodiazepines were more likely to stagnate on the 'if' rather than the 'how.' Conclusion The initiation, style and content of the conversations varied between PPI and benzodiazepine users, suggesting that healthcare providers will need to tailor deprescribing conversations accordingly.
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Affiliation(s)
- Justin P Turner
- Facultés de Pharmacie, Université de Montréal Research Center of Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | - Claude Richard
- Équipe de Recherche en Soins de Première Ligne, Centre Intégré de Santé et de Services Sociaux de Laval, Québec, Canada
| | - Marie-Thérèse Lussier
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Montréal, Montréal, Québec, CanadaÉquipe de Recherche en Soins de Première Ligne, Centre Intégré de Santé et de Services Sociaux de Laval, Québec, Canada
| | - Marie-Eve Lavoie
- Équipe de Recherche en Soins de Première Ligne, Centre Intégré de Santé et de Services Sociaux de Laval, Québec, Canada
| | - Barbara Farrell
- Geriatric Day Hospital, Bruyère Continuing Care, Bruyère Research Institute and CT Lamont Primary Health Care Research Centre, Ottawa, Ontario, Canada Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Cara Tannenbaum
- Facultés de Médecine et de Pharmacie, Université de MontréalResearch Center of Institut Universitaire de Gériatrie de Montréal, Québec, Canada
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Thompson W, Reeve E, Moriarty F, Maclure M, Turner J, Steinman MA, Conklin J, Dolovich L, McCarthy L, Farrell B. Deprescribing: Future directions for research. Res Social Adm Pharm 2018; 15:801-805. [PMID: 30241876 DOI: 10.1016/j.sapharm.2018.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 01/11/2023]
Abstract
A World Café workshop was held at the Bruyère Evidence-Based Deprescribing Guidelines Symposium in March 2018 with 30 participants (researchers, clinicians, policy makers, stakeholders). This workshop explored priorities for future work in the field of deprescribing and deprescribing guidelines through group discussion. The discussions were guided by the following questions: (1) What are deprescribing research priorities (to inform guideline development), (2) What outcome measures are important for developing deprescribing guidelines, and (3) How do we evaluate the implementation and effectiveness of deprescribing guidelines? Discussion from all 3 questions identified 6 main priority areas: (1) conducting high-quality and long-term clinical trials that measure patient-important outcomes, (2) focusing on patient involvement and perspectives, (3) investigating the pharmacoeconomics of deprescribing interventions, (4) understanding deprescribing interventions in different populations, (5) generating evidence on clinical management during deprescribing (e.g. managing adverse drug withdrawal effects, subsequent re-prescribing), and (6) implementing interventions in clinical practice. These topics represent what a group of experienced researchers, clinicians, and stakeholders in the field collectively felt was important to consider for design and implementation of future deprescribing studies. The aim is for these findings to stimulate future discussions and be considered by granting agencies, policy makers, deprescribing research networks, and individual researchers planning future deprescribing studies.
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Affiliation(s)
- Wade Thompson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000C, Odense, Denmark.
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, NS, Canada.
| | - Frank Moriarty
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, D02 YN77, Dublin, Ireland.
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2775 Laurel Street, V5Z 1M9, Vancouver, British Columbia, Canada.
| | - Justin Turner
- University of Montreal, Centre de recherche, Institut Universitaire de Gériatrie de Montréal, 4545 Chemin Queen Mary, H3W 1W4, Montréal, Quebec, Canada.
| | - Michael A Steinman
- Division of Geriatrics, Department of Medicine, University of California San Francisco, 4150 Clement St., Box 181G, 94121, San Francisco, USA.
| | - James Conklin
- Bruyère Research Institute, Ottawa, Ontario, Canada; Concordia University, Montreal, Quebec, Canada.
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2, Toronto, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Lisa McCarthy
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., M5S 1B2, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Barbara Farrell
- Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.
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Farrell B, Conklin J, Dolovich L, Irving H, Maclure M, McCarthy L, Moriarty F, Pottie K, Raman-Wilms L, Reeve E, Thompson W. Deprescribing guidelines: An international symposium on development, implementation, research and health professional education. Res Social Adm Pharm 2018; 15:780-789. [PMID: 30241875 DOI: 10.1016/j.sapharm.2018.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 01/08/2023]
Abstract
Deprescribing is a clinically important and feasible innovation that ensures medication efficacy, reduces harms, and mitigates polypharmacy. It involves reducing doses or stopping medications that are not useful, no longer needed, or which may be causing harm. It may also involve changing to a safer agent or using non-pharmacological approaches for care instead. Clinical guidelines combined with behaviour changes (of health care providers (HCPs), the public, and health care decision-makers) are needed to integrate deprescribing into routine practice. Using rigorous international standards, the Bruyère Research Institute Deprescribing Guidelines research team validated a ground-breaking deprescribing guideline methodology and developed or co-developed 5 evidence-based deprescribing guidelines. In March 2018, the team hosted an international symposium convening HCPs, researchers, public agencies, policymakers, and patient advocates in Ottawa, Ontario, Canada. This 3-day symposium aimed to facilitate knowledge exchange amongst guideline developers, users, and the public; initiate partnerships and collaborations for new deprescribing guideline recommendations and effectiveness research; and to continue work on HCP deprescribing education activities. An interprofessional planning committee developed an overall agenda, and small groups worked on session objectives and formats for different components: methods for rigorous deprescribing guideline development, implementation experiences, research/evaluation experiences and educational needs. Through a series of keynote speakers, panel discussions, and small working groups, the symposium provided a forum for participants to meet one another, learn about their different experiences with deprescribing guidelines, and develop collaborations for future initiatives. One hundred thirty participants, from 10 countries and representing over 100 institutions and organizations took part. Symposium proceedings are presented in this issue of RSAP for sharing with the wider community engaged in the care of patients with problematic polypharmacy.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, 43 Bruyère St., K1N 5C8, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Canada.
| | - James Conklin
- Bruyère Research Institute, 43 Bruyère St., K1N 5C8, Ottawa, Ontario, Canada; Concordia University, Montreal, Quebec, Canada.
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2, Toronto, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Hannah Irving
- Bruyère Research Institute, 43 Bruyère St., K1N 5C8, Ottawa, Ontario, Canada.
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2775 Laurel Street, V5Z 1M9, Vancouver, British Columbia, Canada.
| | - Lisa McCarthy
- Women's College Research Institute, 76 Grenville St., M5S 1B2, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Frank Moriarty
- HRB Centre for Primary Health Care Research, Royal College of Surgeons in Ireland, 123 St Stephen's Green, D02 YN77, Dublin, Ireland.
| | - Kevin Pottie
- Bruyère Research Institute, 43 Bruyère St., K1N 5C8, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Epidemiology and Community Medicine. University of Ottawa, Ottawa, Ontario, Canada.
| | - Lalitha Raman-Wilms
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, 750 McDermot Avenue, R3E 0T5, Winnipeg, Manitoba, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, M5S 3M2, Toronto, Ontario, Canada.
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, NS, Canada.
| | - Wade Thompson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsøwsvej 9, Odense, 5000 C, Denmark.
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Pottie K, Thompson W, Davies S, Grenier J, Sadowski CA, Welch V, Holbrook A, Boyd C, Swenson R, Ma A, Farrell B. [Not Available]. Can Fam Physician 2018; 64:e209-e224. [PMID: 29760269 PMCID: PMC5951664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objectif Formuler des lignes directrices fondées sur les données probantes visant à aider les cliniciens à décider du moment et de la façon sécuritaire de réduire la dose des agonistes des récepteurs des benzodiazépines (BZRA) pour mettre fin au traitement; se concentrer sur le niveau le plus élevé des données disponibles et obtenir les commentaires des professionnels de première ligne durant le processus de rédaction, de révision et d’adoption des lignes directrices. Méthodes L’équipe comptait 8 cliniciens (1 médecin de famille, 2 psychiatres, 1 psychologue clinique, 1 pharmacologue clinique, 2 pharmaciennes cliniques et 1 gériatre) et une spécialiste de la méthodologie; les membres ont divulgué tout conflit d’intérêts. Nous avons eu recours à un processus systématique, y compris l’approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) pour formuler les lignes directrices. Les données ont été générées par une revue systématique d’études portant sur la déprescription des BZRA contre l’insomnie, de même que par une revue des revues sur les torts liés à la poursuite du traitement par BZRA et des synthèses narratives sur les préférences des patients et les répercussions sur les ressources. Ces données et le score GRADE de qualité des données ont servi à formuler les recommandations. L’équipe a peaufiné le texte sur le contenu et les recommandations des lignes directrices par consensus et a synthétisé les considérations cliniques afin de répondre aux questions des cliniciens de première ligne. Une version préliminaire des lignes directrices a été révisée par les cliniciens et les intervenants. Recommandations Nous recommandons d’offrir la déprescription (réduction lente de la dose) des BZRA à tous les patients âgés (≥ 65 ans) sous un BZRA, sans égard à la durée de l’usage, et suggérons d’offrir la déprescription (réduction lente de la dose) à tous les adultes de 18 à 64 qui prennent un BZRA depuis plus de 4 semaines. Ces recommandations visent les patients qui prennent un BZRA contre l’insomnie seule (insomnie primaire) ou l’insomnie comorbide lorsque les comorbidités sous-jacentes sont efficacement prises en charge. Ces lignes directrices ne visent pas les personnes atteintes d’autres troubles non traités du sommeil ou d’anxiété, de dépression, ou d’autres troubles physiques ou de santé mentale pouvant causer ou aggraver l’insomnie. Conclusion Les agonistes des récepteurs des benzodiazépines sont liés à des torts, et leur effet thérapeutique serait bref. La réduction graduelle de la dose de BZRA améliore le taux d’abandon comparativement aux soins habituels, et ce, sans causer de torts graves. Les patients seraient plus ouverts à une conversation sur la déprescription s’ils comprennent le pourquoi (potentiel de torts), participent à l’élaboration du plan de réduction de la dose et reçoivent des conseils en matière de comportement. Les présentes lignes directrices émettent des recommandations pour décider du moment et de la façon de réduire la dose de BZRA pour mettre fin au traitement. Elles visent à contribuer au processus de décision conjointement avec le patient et non à le dicter.
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Affiliation(s)
- Kevin Pottie
- Professeur agrégé au département de médecine familiale et à l'École d'épidémiologie et de santé publique à l'Institut de recherche Bruyère de l'Université d'Ottawa, en Ontario.
| | - Wade Thompson
- Étudiant à la maîtrise à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa
| | - Simon Davies
- Professeur agrégé au département de psychiatrie de l'Université de Toronto, en Ontario, et scientifique clinicien et psychiatre titulaire à la division de gérontopsychiatrie au Centre de toxicomanie et de santé mentale à Toronto
| | - Jean Grenier
- Investigateur clinicien au département de médecine familiale de l'Université d'Ottawa et scientifique clinique au Centre de recherche C.T. Lamont en soins de santé primaire de l'Institut de recherche Bruyère
| | - Cheryl A Sadowski
- Professeure à la faculté de pharmacie et de sciences pharmaceutiques de l'Université de l'Alberta à Edmonton. Lors de l'élaboration des lignes directrices
| | - Vivian Welch
- Directrice du Centre des méthodes à l'Institut de recherche Bruyère et professeure adjointe à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa
| | - Anne Holbrook
- Directrice de la division de pharmacologie clinique et professeure au département de médecine de l'Université McMaster à Hamilton, en Ontario; elle est aussi scientifique principale au Centre for Evaluation of Medicines du St Joseph's Healthcare Hamilton
| | - Cynthia Boyd
- Professeure au département de médecine de la division de médecine gériatrique et de gérontologie à la Johns Hopkins University School of Medicine à Baltimore, MD
| | - Robert Swenson
- Psychiatre à l'Hôpital d'Ottawa et professeur titulaire au département de psychiatrie de l'Université d'Ottawa
| | - Andy Ma
- Résident en pharmacie à l'Hôpital d'Ottawa
| | - Barbara Farrell
- Professeure adjointe au département de médecine familiale de l'Université d'Ottawa, professeure adjointe auxiliaire à l'École de pharmacie de l'Université de Waterloo en Ontario et scientifique à l'Institut de recherche Bruyère
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Pottie K, Thompson W, Davies S, Grenier J, Sadowski CA, Welch V, Holbrook A, Boyd C, Swenson R, Ma A, Farrell B. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Can Fam Physician 2018; 64:339-351. [PMID: 29760253 PMCID: PMC5951648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists (BZRAs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS The overall team comprised 8 clinicians (1 family physician, 2 psychiatrists, 1 clinical psychologist, 1 clinical pharmacologist, 2 clinical pharmacists, and 1 geriatrician) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated by conducting a systematic review of BZRA deprescribing trials for insomnia, as well as performing a review of reviews of the harms of continued BZRA use and narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality of evidence ratings were used to generate recommendations. The team refined guideline content and recommendations through consensus and synthesized clinical considerations to address front-line clinician questions. The draft guideline was reviewed by clinicians and stakeholders. RECOMMENDATIONS We recommend that deprescribing (tapering slowly) of BZRAs be offered to elderly adults (≥ 65 years) who take BZRAs, regardless of duration of use, and suggest that deprescribing (tapering slowly) be offered to adults aged 18 to 64 who have used BZRAs for more than 4 weeks. These recommendations apply to patients who use BZRAs to treat insomnia on its own (primary insomnia) or comorbid insomnia where potential underlying comorbidities are effectively managed. This guideline does not apply to those with other sleep disorders or untreated anxiety, depression, or other physical or mental health conditions that might be causing or aggravating insomnia. CONCLUSION Benzodiazepine receptor agonists are associated with harms, and therapeutic effects might be short term. Tapering BZRAs improves cessation rates compared with usual care without serious harms. Patients might be more amenable to deprescribing conversations if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice. This guideline provides recommendations for making decisions about when and how to reduce and stop BZRAs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.
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Affiliation(s)
- Kevin Pottie
- Associate Professor in the Department of Family Medicine and the Department of Epidemiology and Community Medicine at the Bruyère Research Institute at the University of Ottawa in Ontario.
| | - Wade Thompson
- Master's student in the School of Epidemiology and Public Health at the University of Ottawa at the time of guideline development
| | - Simon Davies
- Associate Professor in the Department of Psychiatry at the University of Toronto in Ontario and Clinician Scientist and staff psychiatrist in the Geriatric Psychiatry Division at the Centre for Addiction and Mental Health in Toronto
| | - Jean Grenier
- Clinician Investigator in the Department of Family Medicine at the University of Ottawa and Clinical Scientist at the C.T. Lamont Centre for Primary Health Care Research of the Bruyère Research Institute
| | - Cheryl A Sadowski
- Professor in the Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta in Edmonton
| | - Vivian Welch
- Director of the Methods Centre at the Bruyère Research Institute and Assistant Professor in the School of Epidemiology and Public Health at the University of Ottawa at the time of guideline development
| | - Anne Holbrook
- Director of the Division of Clinical Pharmacology and Professor in the Department of Medicine at McMaster University in Hamilton, Ont, and Senior Scientist at the Centre for Evaluation of Medicines of St Joseph's Healthcare Hamilton
| | - Cynthia Boyd
- Professor in the Department of Medicine in the Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine in Baltimore, MD
| | - Robert Swenson
- Psychiatrist at the Ottawa Hospital and Full Professor in the Department of Psychiatry at the University of Ottawa
| | - Andy Ma
- Pharmacy resident at the Ottawa Hospital
| | - Barbara Farrell
- Assistant Professor in the Department of Family Medicine at the University of Ottawa, Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario, and Scientist at the Bruyère Research Institute
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Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, Raman-Wilms L, Rojas-Fernandez C, Sinha S, Thompson W, Welch V, Wiens A. Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia: Evidence-based clinical practice guideline. Can Fam Physician 2018; 64:17-27. [PMID: 29358245 PMCID: PMC5962971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated from a Cochrane systematic review of antipsychotic deprescribing trials for the behavioural and psychological symptoms of dementia, and a systematic review was conducted to assess the evidence behind the benefits of using antipsychotics for insomnia. A review of reviews of the harms of continued antipsychotic use was performed, as well as narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality-of-evidence ratings were used to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. RECOMMENDATIONS We recommend deprescribing antipsychotics for adults with behavioural and psychological symptoms of dementia treated for at least 3 months (symptoms stabilized or no response to an adequate trial) and for adults with primary insomnia treated for any duration or secondary insomnia in which underlying comorbidities are managed. A decision-support algorithm was developed to accompany the guideline. CONCLUSION Antipsychotics are associated with harms and can be safely tapered. Patients and caregivers might be more amenable to deprescribing if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice or management. This guideline provides recommendations for making decisions about when and how to reduce the dose of or stop antipsychotics. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients and families.
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Affiliation(s)
- Lise M Bjerre
- Assistant Professor in the Department of Family Medicine and in the School of Epidemiology and Public Health at the University of Ottawa in Ontario, Scientist in the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute, and Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES).
| | - Barbara Farrell
- Assistant Professor in the Department of Family Medicine at the University of Ottawa, Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario, and Scientist at the Bruyère Research Institute at the University of Ottawa
| | - Matthew Hogel
- Research Associate at the Bruyère Research Institute at the time of guideline development
| | - Lyla Graham
- Medical Director of St Patrick's Home of Ottawa and Assistant Professor in the Department of Family Medicine at the University of Ottawa
| | - Geneviève Lemay
- Assistant Professor of Medicine at the University of Ottawa, Chief of Geriatric Services at Hôpital Montfort, and a staff geriatrician with the Ottawa Hospital Division of Geriatrics
| | - Lisa McCarthy
- Scientist at the Women's College Research Institute of Women's College Hospital in Toronto, Ont, and Assistant Professor with the Leslie Dan Faculty of Pharmacy and the Department of Family and Community Medicine at the University of Toronto
| | - Lalitha Raman-Wilms
- Associate Professor and Associate Dean of Professional Programs in the Leslie Dan Faculty of Pharmacy at the University of Toronto at the time of guideline development
| | - Carlos Rojas-Fernandez
- Schlegel Research Chair in Geriatric Pharmacotherapy at the Schlegel-UW Research Institute on Ageing and the School of Pharmacy at the University of Waterloo at the time of guideline development
| | - Samir Sinha
- Director of Geriatrics at Mount Sinai Hospital and the University Health Network hospitals in Toronto, Assistant Professor in the Department of Medicine, the Department of Family and Community Medicine, and the Institute for Health Policy, Management and Evaluation at the University of Toronto, and Assistant Professor in the Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine in Baltimore, MD
| | - Wade Thompson
- Master's student in the School of Epidemiology and Public Health at the University of Ottawa at the time of guideline development
| | - Vivian Welch
- Director of the Methods Centre at the Bruyère Research Institute and Assistant Professor in the School of Epidemiology and Public Health at the University of Ottawa at the time of guideline development
| | - Andrew Wiens
- Associate Professor and Head of the Division of Geriatric Psychiatry in the Department of Psychiatry at the University of Ottawa
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Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, Raman-Wilms L, Rojas-Fernandez C, Sinha S, Thompson W, Welch V, Wiens A. Déprescription des antipsychotiques pour les symptômes comportementaux et psychologiques de la démence et l’insomnie. Can Fam Physician 2018; 64:e1-e12. [PMID: 29358261 PMCID: PMC5962991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectif Élaborer un guide de pratique clinique fondé sur des données probantes pour aider les cliniciens à prendre des décisions quant au moment et à la façon de réduire et de cesser les antipsychotiques en toute sécurité; insister sur les données les plus probantes et solliciter les contributions des professionnels des soins primaires pour l’élaboration, la révision et l’approbation des lignes directrices. Méthodologie L’équipe comptait 9 cliniciens (1 médecin de famille, 1 médecin de famille spécialisée en soins de longue durée, 1 psychiatre gériatrique, 2 gériatres, 4 pharmaciens) et une spécialiste en méthodologie; les membres ont divulgué leurs conflits d’intérêts. Un processus systématique a été utilisé pour l’élaboration du guide de pratique, y compris le protocole GRADE (Grading of Recommendations Assessment, Development and Evaluation). Les données probantes ont été tirées d’une revue systématique de Cochrane portant sur des études sur la déprescription des antipsychotiques pour les symptômes comportementaux et psychologiques de la démence. Nous avons effectué une revue systématique pour évaluer les données probantes étayant les bienfaits de l’utilisation des antipsychotiques pour traiter l’insomnie. Nous avons examiné les revues portant sur les torts associés à l’utilisation des antipsychotiques sur une base continue, et nous avons fait une synthèse narrative des préférences des patients et des répercussions sur le plan des ressources. Ces données probantes, de même que l’évaluation de la qualité des données selon GRADE, ont été utilisées pour produire les recommandations. L’équipe a peaufiné le contenu du guide de pratique et le libellé des recommandations, et elle a résumé les considérations d’ordre clinique pour répondre aux questions courantes des cliniciens de première ligne. Une ébauche du guide de pratique a été distribuée à des cliniciens et à des intervenants aux fins d’examen. Des révisions ont été apportées au texte à chaque étape. Recommandations Nous recommandons la déprescription des antipsychotiques chez les adultes ayant des symptômes comportementaux et psychologiques de démence traités depuis au moins 3 mois (symptômes stabilisés ou sans réponse après un essai adéquat) et chez les adultes souffrant d’insomnie primaire, quelle que soit la durée du traitement, ou d’une insomnie secondaire lorsque les comorbidités sous-jacentes sont prises en charge. Un algorithme décisionnel accompagne le guide de pratique clinique. Conclusion Les antipsychotiques sont associés à des préjudices et il est possible de procéder à un sevrage en toute sécurité. Les patients et leurs aidants peuvent être plus réceptifs à la déprescription s’ils comprennent ce qui la justifie (potentiel de préjudices), s’ils participent à l’élaboration du plan de sevrage et si on leur offre des conseils ou une prise en charge quant aux comportements. Le présent guide de pratique clinique offre des recommandations pour décider du moment et de la façon de réduire la dose d’antipsychotiques ou de les cesser complètement. Les recommandations servent à aider à prendre les décisions conjointement avec les patients et leur famille plutôt qu’à les dicter.
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Affiliation(s)
- Lise M Bjerre
- Professeure adjointe au Département de médecine familiale et à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa, en Ontario, scientifique au Centre de recherche C.T. Lamont en soins de santé primaires de l'Institut de recherche Bruyère et scientifique auxiliaire à l'Institut de recherche en services de santé (IRSS).
| | - Barbara Farrell
- Professeure adjointe au Département de médecine familiale à l'Université d'Ottawa, professeure adjointe à la Faculté de pharmacie de l'Université de Waterloo, en Ontario, et scientifique à l'Institut de recherche Bruyère de l'Université d'Ottawa
| | - Matthew Hogel
- Associé de recherche à l'Institut de recherche Bruyère au moment de l'élaboration du guide de pratique
| | - Lyla Graham
- Directrice médicale du St Patrick's Home of Ottawa et professeure adjointe au Département de médecine familiale de l'Université d'Ottawa
| | - Geneviève Lemay
- Professeure adjointe de médecine à l'Université d'Ottawa, directrice des Services de gériatrie à l'Hôpital Montfort, et gériatre membre du personnel de la Division de gériatrie de L'Hôpital d'Ottawa
| | - Lisa McCarthy
- Scientifique à l'Institut de recherche du Women's College Hospital à Toronto, en Ontario, et professeure adjointe à la Faculté de pharmacie Leslie Dan et au Département de médecine familiale et communautaire de l'Université de Toronto
| | - Lalitha Raman-Wilms
- Professeure agrégée et vice-doyenne des Programmes professionnels à la Faculté de pharmacie Leslie Dan de l'Université de Toronto au moment de l'élaboration du guide de pratique
| | - Carlos Rojas-Fernandez
- Titulaire de la Chaire de recherche Schlegel en pharmacothérapie gériatrique à l'Institut de recherche Schlegel-UW sur le vieillissement et à la Faculté de pharmacie de l'Université de Waterloo au moment de l'élaboration du guide de pratique
| | - Samir Sinha
- Directeur de la Gériatrie à l'Hôpital Mount Sinai et des hôpitaux universitaires du réseau de la santé à Toronto, professeur adjoint au Département de médecine, au Département de médecine familiale et communautaire, et à l'Institute for Health Policy, Management and Evaluation de l'Université de Toronto, et professeur adjoint à la Division de médecine gériatrique et de gérontologie de la Faculté de médecine de l'Université Johns Hopkins à Baltimore, MD (É.-U.)
| | - Wade Thompson
- Étudiant à la maîtrise à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa au moment de l'élaboration du guide de pratique
| | - Vivian Welch
- Directrice du Centre de méthodologie de l'Institut de recherche Bruyère et professeure adjointe à l'École d'épidémiologie et de santé publique de l'Université d'Ottawa au moment de l'élaboration du guide de pratique
| | - Andrew Wiens
- Professeur agrégé et directeur de la Division de psychiatrie gériatrique du Département de psychiatrie de l'Université d'Ottawa
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Muscedere J, Kim P, Aitken P, Gaucher M, Osborn R, Farrell B, Holroyd-Leduc J, Mallery L, Siu H, Downar J, Lee TC, McDonald E, Burry L. Proceedings of the Canadian Frailty Network Summit: Medication Optimization for Frail Older Canadians, Toronto, Monday April 24, 2017. Can Geriatr J 2017; 20:253-263. [PMID: 29296132 PMCID: PMC5740949 DOI: 10.5770/cgj.20.293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Appropriate and optimal use of medication and polypharmacy are especially relevant to the care of older Canadians living with frailty, often impacting their health outcomes and quality of life. A majority (two thirds) of older adults (65 or older) are prescribed five or more drug classes and over one-quarter are prescribed 10 or more drugs. The risk of adverse drug-induced events is even greater for those aged 85 or older where 40% are estimated to take drugs from 10 or more drug classes. The Canadian Frailty Network (CFN), a pan-Canadian non-for-profit organization funded by the Government of Canada through the Networks of Centres of Excellence Program (NCE), is dedicated to improving the care of older Canadian living with frailty and, as part of its mandate, convened a meeting of stakeholders from across Canada to seek their perspectives on appropriate medication prescription. The CFN Medication Optimization Summit identified priorities to help inform the design of future research and knowledge mobilization efforts to facilitate optimal medication prescribing in older adults living with frailty. The priorities were developed and selected through a modified Delphi process commencing before and concluding during the summit. Herein we describe the overall approach/process to the summit, a summary of all the presentations and discussions, and the top ten priorities selected by the participants.
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Affiliation(s)
- John Muscedere
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada
- Canadian Frailty Network, Kingston, ON, Canada
| | - Perry Kim
- Canadian Frailty Network, Kingston, ON, Canada
| | - Peter Aitken
- Partnerships, Development and Government Relations, Canadian Frailty Network, Kingston, ON, Canada
| | - Michael Gaucher
- Pharmaceuticals and Health Workforce Information Services, Canadian Institute of Health Information, Ottawa, ON, Canada
| | - Robin Osborn
- International Health Policy and Practice Innovations for the Commonwealth Fund, New York, NY, U.S.A
| | - Barbara Farrell
- Bruyère Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jayna Holroyd-Leduc
- Medicine and Community Health Science, University of Calgary, Calgary, AB, Canada
| | - Laurie Mallery
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Henry Siu
- Family Medicine at McMaster University, Hamilton, ON, Canada
| | - James Downar
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Todd C. Lee
- McGill University Health Centre, Montreal, HQ, Canada
| | | | - Lisa Burry
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
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Farrell B, Black C, Thompson W, McCarthy L, Rojas-Fernandez C, Lochnan H, Shamji S, Upshur R, Bouchard M, Welch V. Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline. Can Fam Physician 2017; 63:832-843. [PMID: 29138153 PMCID: PMC5685444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper, stop, or switch antihyperglycemic agents in older adults. METHODS We focused on the highest level of evidence available and sought input from primary care professionals in guideline development, review, and endorsement processes. Seven clinicians (2 family physicians, 3 pharmacists, 1 nurse practitioner, and 1 endocrinologist) and a methodologist comprised the overall team; members disclosed conflicts of interest. We used a rigorous process, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, for guideline development. We conducted a systematic review to assess evidence for the benefits and harms of deprescribing antihyperglycemic agents. We performed a review of reviews of the harms of continued antihyperglycemic medication use, and narrative syntheses of patient preferences and resource implications. We used these syntheses and GRADE quality-of-evidence ratings to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. A decision-support algorithm was developed to accompany the guideline. RECOMMENDATIONS We recommend deprescribing antihyperglycemic medications known to contribute to hypoglycemia in older adults at risk or in situations where antihyperglycemic medications might be causing other adverse effects, and individualizing targets and deprescribing accordingly for those who are frail, have dementia, or have a limited life expectancy. CONCLUSION This guideline provides practical recommendations for making decisions about deprescribing antihyperglycemic agents. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.
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Affiliation(s)
- Barbara Farrell
- Scientist at the Bruyère Research Institute and C.T. Lamont Primary Health Care Research Centre, Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, and Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario.
| | - Cody Black
- Research Coordinator at the Bruyère Research Institute
| | - Wade Thompson
- Research Coordinator at the Bruyère Research Institute and a master's candidate in the School of Epidemiology, Public Health and Preventive Medicine at the University of Ottawa
| | - Lisa McCarthy
- Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario and a pharmacy scientist at Women's College Hospital Research Institute
| | - Carlos Rojas-Fernandez
- Assistant Professor in the School of Pharmacy and the School of Public Health and Health Systems at the University of Waterloo and Schlegel Research Chair in Geriatric Pharmacotherapy at the Schlegel-University of Waterloo Research Institute on Ageing
| | - Heather Lochnan
- Associate Professor of Medicine at the University of Ottawa and is an endocrinologist at the Ottawa Hospital
| | - Salima Shamji
- Assistant Professor in the Department of Family Medicine at the University of Ottawa
| | - Ross Upshur
- Professor in the Dalla Lana School of Public Health at the University of Toronto
| | - Manon Bouchard
- Nurse practitioner with the Bruyère Academic Family Health Team
| | - Vivian Welch
- Assistant Professor in the School of Epidemiology, Public Health and Preventive Medicine, Deputy Director of the Centre for Global Health at the University of Ottawa, and a clinical epidemiology methodologist at the Bruyère Research Institute
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Farrell B, Black C, Thompson W, McCarthy L, Rojas-Fernandez C, Lochnan H, Shamji S, Upshur R, Bouchard M, Welch V. [Not Available]. Can Fam Physician 2017; 63:e452-e465. [PMID: 29138168 PMCID: PMC5685459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objectif Formuler des lignes directrices fondées sur les données probantes afin d’aider les cliniciens à décider du moment et de la façon sécuritaire de réduire la dose des antihyperglycémiants, de mettre fin au traitement ou de passer à un autre agent chez les personnes âgées. Méthodes Nous nous sommes concentrés sur les données les plus probantes disponibles et avons cherché à obtenir les commentaires des professionnels de première ligne durant le processus de rédaction, de révision et d’adoption des lignes directrices. L’équipe était formée de 7 professionnels de la santé (2 médecins de famille, 3 pharmaciens, 1 infirmière praticienne et 1 endocrinologue) et d’une spécialiste de la méthodologie; les membres ont divulgué tout conflit d’intérêts. Nous avons eu recours à un processus rigoureux, y compris l’approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) pour formuler les lignes directrices. Nous avons effectué une revue systématique dans le but d’évaluer les données probantes indiquant les bienfaits et les torts liés à la déprescription des antihyperglycémiants. Nous avons révisé les revues des torts liés à la poursuite du traitement antihyperglycémiant, et effectué des synthèses narratives des préférences des patients et des répercussions sur les ressources. Ces synthèses et évaluations de la qualité des données selon l’approche GRADE ont servi à formuler les recommandations. L’équipe a peaufiné le texte sur le contenu et les recommandations des lignes directrices par consensus et a synthétisé les considérations cliniques afin de répondre aux questions courantes des cliniciens de première ligne. Une version préliminaire des lignes directrices a été distribuée aux cliniciens et aux intervenants aux fins d’examen, et des révisions ont été apportées au texte à chaque étape. Un algorithme d’appui décisionnel a été conçu pour accompagner les lignes directrices. Recommandations Nous recommandons de déprescrire les antihyperglycémiants reconnus pour contribuer à l’hypoglycémie chez les personnes âgées à risque ou dans les situations où les antihyperglycémiants pourraient causer d’autres effets indésirables, et d’individualiser les cibles et de déprescrire en conséquence chez les personnes frêles, atteintes de démence ou dont l’espérance de vie est limitée. Conclusion Les présentes lignes directrices émettent des recommandations pratiques pour décider du moment et de la façon de déprescrire les antihyperglycémiants. Elles visent à contribuer au processus de décision conjointement avec le patient et non à le dicter.
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Affiliation(s)
- Barbara Farrell
- Scientifique à l'Institut de recherche Élisabeth-Bruyère et au Centre de recherche C.T. Lamont en soins de santé primaires, professeure adjointe au Département de médecine familiale de l'Université d'Ottawa et professeure adjointe auxiliaire à la Faculté de pharmacie de l'Université de Waterloo, en Ontario.
| | - Cody Black
- Coordonnateur de la recherche à l'Institut de recherche Élisabeth-Bruyère
| | - Wade Thompson
- Coordonnateur de la recherche à l'Institut de recherche Élisabeth-Bruyère et candidat à la maîtrise à la Faculté d'épidémiologie, de santé publique et de médecine préventive de l'Université d'Ottawa
| | - Lisa McCarthy
- Professeure adjointe à la Faculté de pharmacie Leslie Dan de l'Université de Toronto, en Ontario, et scientifique pharmacienne à l'Institut de recherche de l'Hôpital Women's College
| | - Carlos Rojas-Fernandez
- Professeur adjoint à la Faculté de pharmacie ainsi qu'à la Faculté de santé publique et des systèmes de santé de l'Université de Waterloo, et titulaire de la chaire de recherche Schlegel en pharmacothérapie gériatrique à l'Institut de recherche Schlegel-UW sur le vieillissement
| | - Heather Lochnan
- Professeure agrégée de médecine à l'Université d'Ottawa et endocrinologue à l'Hôpital d'Ottawa
| | - Salima Shamji
- Professeure adjointe au Département de médecine familiale de l'Université d'Ottawa
| | - Ross Upshur
- Professeur à la Dalla Lana School of Public Health de l'Université de Toronto
| | - Manon Bouchard
- Infirmière praticienne dans l'Équipe de santé familiale universitaire Bruyère
| | - Vivian Welch
- Professeure adjointe à la Faculté d'épidémiologie, de santé publique et de médecine préventive de l'Université d'Ottawa, directrice adjointe du Centre de santé mondiale de l'Université d'Ottawa et spécialiste de méthodologie épidémiologique clinique à l'Institut de recherche Élisabeth-Bruyère
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48
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Farrell B, Conklin J, Raman-Wilms L, McCarthy L, Pottie K, Rojas-Fernandez C, Bjerre L, Irving H. DEVELOPMENT AND IMPLEMENTATION OF DEPRESCRIBING GUIDELINES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Farrell
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
- University of Waterloo, Kitchener, Ontario, Canada,
| | - J. Conklin
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- Concordia University, Montreal, Quebec, Canada,
| | | | - L. McCarthy
- University of Toronto, Toronto, Ontario, Canada,
- Women’s College Hospital, Toronto, Ontario, Canada
| | - K. Pottie
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
| | | | - L. Bjerre
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
| | - H. Irving
- Bruyere Research Institute, Ottawa, Ontario, Canada,
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Tannenbaum C, Morgan S, Farrell B, Trimble J, Currie J, Shaw J, Silvius J. ENABLING KNOWLEDGE TRANSLATION THROUGH THE CANADIAN DEPRESCRIBING NETWORK. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - S. Morgan
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - B. Farrell
- Bruyere Research Institute, Ottawa, Ontario, Canada,
| | - J. Trimble
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - J. Currie
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - J. Shaw
- Women’s College Hospital, Toronto, Ontario, Canada
| | - J. Silvius
- Alberta Health Services, Calgery, Alberta, Canada,
- University of Calgery, Calgery, Alberta, Canada,
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Thompson W, Black C, Welch V, Farrell B, Bjerre LM, Tugwell P. Patient Values and Preferences Surrounding Proton Pump Inhibitor Use: A Scoping Review. Patient 2017; 11:17-28. [DOI: 10.1007/s40271-017-0258-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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