Assessment of Patient-Preferred Language to Achieve Goal-Aligned Deprescribing in Older Adults

Green, Ariel R.; Aschmann, Hélène E; Boyd, Cynthia M.; Schoenborn, Nancy L.

doi:10.1001/jamanetworkopen.2021.2633

Cited by 31 publications

(34 citation statements)

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“…Dentro de las causas de deprescripción, la mayoría de los artículos señalan a la polifarmacia como la causa principal, seguida de la prescripción inapropiada y el uso de PIM (Duncan et al, 2017;Green et al, 2021). Adicionalmente, la presencia de comorbilidades se menciona como un factor desencadenante para la deprescripción como así mismo la presencia de síndromes geriátricos (Gavilán-Moral et al, 2012).…”

Section: Resultsunclassified

“…Adicionalmente, la presencia de comorbilidades se menciona como un factor desencadenante para la deprescripción como así mismo la presencia de síndromes geriátricos (Gavilán-Moral et al, 2012). Green et al (2021), reafirman estos hallazgos en su estudio, en donde se determinaron los medicamentos con más éxito de deprescripción y resultaron ser tanto los fármacos con finalidad preventivos como los usados para el alivio de los síntomas de efectos secundarios.…”

Section: Resultsunclassified

“…En lo que respecta a barreras para la desprescripción, se mencionan la falta de directrices, guías y protocolos de intervención, la resistencia del paciente para abandonar medicamentos que utiliza por mucho tiempo, la presencia del síndrome de retirada, y la reactivación de la enfermedad de base al momento de la retirada (Garfinkel et al, 2010;Duncan et al, 2016;Holmes et al, 2017;Reeve et al, 2017). Complementariamente, también se ha evaluado el lenguaje que entrega a los pacientes mayor seguridad para acoger la deprescripción y contrarrestar la resistencia de los pacientes a dejar de usar fármacos que utilizan por largo tiempo (Green et al, 2021).…”

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Deprescripción de medicamentos en pacientes adulto mayor: contribuyendo a la seguridad de la farmacoterapia

Moya-Olave

Olivares-Pacheco²,

Durán-Rivera³

2022

ARS med

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Introducción: dado el envejecimiento poblacional que vive Chile, se hace cada vez más importante evaluar la seguridad y uso de medicamentos en adultos mayores. Una de las estrategias propuestas a nivel internacional es la deprescripción, que consiste en la disminución o eliminación de fármacos utilizados como tratamiento habitual. Para ello se diseñó esta revisión en donde se propuso analizar la evidencia disponible respecto a la práctica de deprescripción de medicamentos en pacientes adultos mayores. Material y método: se realizó una búsqueda de artículos publicados entre los años 2003 al 2018, en bases de datos como Science Direct, MEDLINE, TripdataBase y Web of Science, seleccionando aquellos con mayor nivel de evidencia. La discusión fue contratada con evidencia actualizada (2018-2021). Resultados: según la revisión la deprescripción, en general, se define como un proceso de retirada de la medicación inapropiada, bajo la supervisión de un profesional; siendo su principal causa la presencia de polifarmacia, y la prescripción de medicamentos potencialmente inapropiados. Los principales fármacos deprescritos con éxito (sin necesidad de ser reincorporados) corresponden a benzodiazepinas, antipsicóticos atípicos, corticoides, antidepresivos tricíclicos, estatinas e inhibidores de la bomba de protones. Conclusión: la deprescripción es un proceso poco estudiado, especialmente a nivel local; sin embargo, podría disminuir los problemas de salud, en especial los referidos a la seguridad de la farmacoterapia en los adultos mayores.

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Deprescripción de medicamentos en pacientes adulto mayor: contribuyendo a la seguridad de la farmacoterapia

Moya-Olave

Olivares-Pacheco²,

Durán-Rivera³

2022

ARS med

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“…At the next visit, Dr Y talks through the rationale for stopping the proton pump inhibitor (ie unlikely to be providing ongoing benefit; harmful number of medicines). 58,59 Dr Y provides Mr C with some information on proton pump inhibitors to take away, and asks 'What questions do you have?' Together they plan a trial of cessation whereby the medication dose is tapered and then eventually stopped.…”

Section: Box 4 Case Study 3: Deprescribingmentioning

confidence: 99%

Medications and doctor–patient communication

et al. 2021

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BackgroundDoctor-patient communication is an important part of safe and effective medication use. There is a lot of evidence about good communication and recognition of several key features that are important when discussing medications. ObjectiveThe aim of this article is to provide evidence-based guidance for general practitioner (GP) communication with patients about starting, reviewing or stopping oral medication. DiscussionCommunication involves listening and asking, as well as imparting information. Creating space for discussions and encouraging patient involvement by asking questions are important. Doctors should deliver core content about why to take medication and actionable messages about how to do so. Regular summing-up and checks of patient understanding are important. Communicating benefits and harms can be facilitated by including numbers, if done carefully (include time periods, natural frequencies, absolute figures). Scheduling extra time, using written resources and enlisting support of pharmacist colleagues can assist with effective communication and help patients navigate the sometimesconfusing world of medications.DOCTOR-PATIENT COMMUNICATION about starting, continuing, changing or stopping medication can sometimes be difficult. Paying attention to communication is an important part of respect for patients as individuals, to foster the principles of patient-centred care and shared decision making, and to promote better medical outcomes. Poor communication between patients and their doctors is a well-established factor in medical errors and adverse events, including medication errors. [1][2][3][4][5][6] As a result, good communication between doctors and patients is now seen as a critical part of involving patients in healthcare and supporting safe and effective use and adherence to medications. 3,[6][7][8][9][10] Communication between general practitioners (GPs) and patients about medications encompasses many diverse approaches across different diseases and healthcare settings, often with very different purposes. 11 These include: providing information or education about medications to enable informed decision making, providing practical behavioural support for medication taking, reminding, skills training (eg correct measurement of liquid medication), counselling and medication review (eg optimisation of regimens, including deprescribing medications where required), and promoting involvement in communication and decision making. 8,[12][13][14][15][16] Good communication is also an important element of shared decision-making practice. It facilitates structured, inclusive discussion about medications and alternatives, and about patient values and priorities in relation to these options, in the context of healthcare management plans. 6,9,10,12,[17][18][19] Communication about medication use with patients (and their carers) has been a major focus of research for decades. 8,15,[20][21][22][23] A vast array of simple and complex approaches to communicating with people about their medications have b...

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“…Similarly, and more importantly, a change in number of medications is in itself presumably of limited value to the patient compared with, for example, improved quality of life or reduced risk of falls. [17][18][19] The second line of reasoning argues that reduction of intensity of therapy combined with documentation of no worsening in health status, that is, 'no change', can be viewed as positive. As such, it either leads to primary outcomes related to safety using a non-inferiority approach or include secondary outcomes related to safety, for example, scoring of symptoms or mortality.…”

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confidence: 99%

Considerations regarding choice of primary outcome in clinical trials in deprescribing

Lundby

Pottegård

2021

Brit J Clinical Pharma

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Assessment of Patient-Preferred Language to Achieve Goal-Aligned Deprescribing in Older Adults

Cited by 31 publications

References 31 publications

Deprescripción de medicamentos en pacientes adulto mayor: contribuyendo a la seguridad de la farmacoterapia

Deprescripción de medicamentos en pacientes adulto mayor: contribuyendo a la seguridad de la farmacoterapia

Medications and doctor–patient communication

Considerations regarding choice of primary outcome in clinical trials in deprescribing

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