Deprescribing: a new goal focused on the patient

Machado‐Alba, Jorge Enrique; Gaviria‐Mendoza, Andrés; Machado‐Duque, Manuel Enrique; Chica, Laura

doi:10.1080/14740338.2017.1273347

Cited by 15 publications

(21 citation statements)

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“…Polypharmacy was identified in almost two‐thirds of patients. This finding has been described as an indicator of inappropriate prescription, and various deprescription strategies have been generated, mainly for elderly patients, to avoid adverse events . However, the context of each patient's situation must be considered because in many cases, the amount of medications is reasonable and fully justified in light of any comorbidities .…”

Section: Discussionmentioning

confidence: 99%

“…This finding has been described as an indicator of inappropriate prescription, and various deprescription strategies have been generated, mainly for elderly patients, to avoid adverse events. 30,31 However, the context of each patient's situation must be considered because in many cases, the amount of medications is reasonable and fully justified in light of any comorbidities. 32 For example, Wauters et al demonstrated that omissions or underprescriptions in the elderly patients is strongly associated with mortality and hospitalisation while polypharmacy showed no clear association with these outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Potential prescribing omissions in patients with cardiovascular disease

2019

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Summary AimsPotential prescribing omissions (PPOs) of medications are a frequent form of inadequate prescription drug practices. The objective of this study was to identify PPOs in a sample of elderly patients with cardiovascular disease. MethodsQuasi‐experimental study. Data were collected from a population database. We included patients who were older than 65 years and had a diagnosis of hypertension, dyslipidaemia, diabetes mellitus, coronary heart disease, heart failure or atrial fibrillation in Colombia. PPOs were determined in a random sample of patients by the START‐2 (Screening Tool to Alert doctors to Right Treatment) criteria. The impact of the PPO was determined after an educational intervention with the doctors who were responsible for treating said patients. ResultsA total of 630 patients, with a median age of 72 years (interquartile range: 68‐78 years), were included; 56.2% were women. The most frequent diagnoses were arterial hypertension (94.1%, n = 593) and dyslipidaemia (56.5%, n = 356). We identified 100 patients (15.9%) with omissions equalling 139 PPOs, and the most common PPOs were due to a lack of angiotensin‐converting enzyme inhibitors in patients associated with heart failure or coronary heart disease (n = 23, 16.5%) and a lack of statins (n = 20; 14.4%) and aspirin (n = 20; 14.4%) in coronary heart disease. Prescription adjustments were achieved in 35 patients (25.2%). ConclusionsPotential prescribing omissions are common in elderly patients with cardiovascular disease. Educational interventions may contribute to a reduced PPO frequency and improve the quality of prescription drug administration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Potential prescribing omissions in patients with cardiovascular disease

2019

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“…11,12 An intervention was, therefore, proposed to review the use of mirabegron and, if appropriate, 7 its deprescribing. [13][14][15][16][17] Studies comparing the use of OAB medication are scarce and do not focus on reviewing treatment and deprescribing. [18][19][20] There is a need to carry out research regarding the real clinical conditions in which such drugs are used.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of an intervention to optimise the use of mirabegron for overactive bladder: a quasi-experimental study in primary care

et al. 2018

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BackgroundOveractive bladder is a composite of lower urinary tract storage symptoms. Pharmacological treatment is widely employed despite markedly modest efficacy data, adverse effects, and costs for the health system.AimTo determine the 12-month efficacy of an intervention delivered by GPs on mirabegron revision and, if appropriate, discontinuation of treatment.Design and settingMulticentre, quasi-experimental study in Barcelona (Catalonia), Spain.MethodTwo groups composed of 17 intervention and 34 control practices were formed. The follow-up period was 12 months, from 1 January to 31 December 2017. A structured intervention was designed consisting of initiatives with GPs and urology/gynaecology specialists. The primary outcome was mirabegron use at 12 months.ResultsOf the 1932 patients, a significant discontinuation in treatment was observed at 12 months’ follow-up in the intervention group (IG) (n = 433 out of 762, 56.8%), in contrast with the control one (CG) (n = 484 out of 1170, 41.4%) (P<0.001). There was also a reduced incorporation of new treatments in the IG (n = 214 out of 762, 28.1%) compared with the CG (n = 595 out of 1170, 50.9%) (P<0.001). In relation to patients with treatment at the beginning and end of the period, there was a decrease of 219 (28.7%) patients in the IG and an increase of 111 (9.5%) in the CG (P<0.001).ConclusionThe structured intervention showed optimisation in the use of mirabegron. When considering discontinuation it is necessary to provide clear data on the benefits and/or risks for patients and their caregivers, as such information is a precondition for shared decision making.

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“…Problems associated with the use of medicines in society continue to be a significant public health burden, with the brunt being borne by older people . The higher risk of medicine‐related adverse events and hospitalisations in older adults is caused primarily by age‐related pharmacokinetic and pharmacodynamic changes, and a higher number of chronic conditions and resultant polypharmacy, which is often associated with the use of potentially inappropriate medicines . Adverse drug events (ADEs) frequently involve predictable high‐risk situations, such as multiple drug use in the elderly, which are amenable to prevention through better systems and ways of working by health professionals.…”

mentioning

confidence: 99%

“…A particular focus of pharmacists within general practices can be the high prevalence of polypharmacy among older adults, which, when coupled with ageassociated physiological changes and comorbidities, provides major challenges in adherence with therapy and avoidance of drug interactions and other adverse events. 4,14 Pharmacists within general practices have ready access to patients' clinical and pathology data, and to the patients and prescribers themselves, enabling the compilation and discussion of fully informed recommendations for deprescribing in patients taking multiple medications. 12,15 It is known that deprescribing initiatives are more likely to be successful if there is close involvement of the GP, especially if the suggestion to reduce medications is made to the patient by the GP.…”

mentioning

confidence: 99%