Deprescribing for older people living in residential aged care facilities: Pharmacist recommendations, doctor acceptance and implementation

Quek, Hui Wen; Etherton‐Beer, Christopher; Page, Amy; McLachlan, Andrew J.; Lo, Sarita; Naganathan, Vasi; Kearney, Leanne; Hilmer, Sarah N.; Comans, Tracy; Mangin, Dee; Lindley, Richard I; Potter, Kathleen

doi:10.1016/j.archger.2022.104910

Cited by 15 publications

(10 citation statements)

References 51 publications

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“…The first question, which refers generically to the deprescription process, shows a high degree of agreement in favour of this practice among professionals who find it beneficial [ 10 ]. Furthermore, these results are in line with the acceptance obtained by clinicians in recent studies, where deprescription has been incorporated into clinical practice [ 11 , 12 ]. Therefore, we can affirm that the trend is positive, that deprescription is gaining support, and that more professionals are advocating its implementation.…”

Section: Discussionsupporting

confidence: 89%

The Barriers to Deprescription in Older Patients: A Survey of Spanish Clinicians

et al. 2023

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Background and objective: There are barriers to deprescription that hinder its implementation in clinical practice. The objective of this study was to analyse the main barriers and limitations of the deprescription process perceived by physicians who care for multipathological patients. Materials and methods: The “deprescription questionnaire of elderly patients” was adapted to an online format and sent to physicians in geriatrics. Question 1 is a reference to establish agreement or disagreement with this practice. The influence of different aspects of deprescription was analysed via the demographic characteristics of the clinicians and perceptions of the various barriers (questions 2–9) by means of bivariate analysis. Based on the latter, a multivariate model was carried out to demonstrate the relationship between barriers and the degree of deprescription agreement among respondents. Results: Of the 72 respondents, 72.2% were in favour of deprescribing. Regarding the analyses, the demographic characteristics did not influence rankings. The deprescription of preventive drugs and consensus with patients were associated with a positive attitude towards deprescribing, while withdrawing drugs prescribed by other professionals, time constraints and patient reluctance emerged as possible barriers. The only factor independently associated with deprescribing was lack of time. Conclusions: Time was found to be the main barrier to deprescription. Training, the creation of multidisciplinary teams and integrated health systems are key facilitators.

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Section: Discussionsupporting

confidence: 89%

The Barriers to Deprescription in Older Patients: A Survey of Spanish Clinicians

et al. 2023

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“…It is possible that one component of the perception and uptake of the medicine management review program overall is its consistency and replicability [40,41]. Standardised question templates for medicine reviews that allow for exibility in reporting depending on the pharmacist work environment may contribute to a higher consistency in issues found, leading to interventions also having a higher degree of replicability [42]. Nonetheless, obstacles for maintaining consistency in medicines review reports include lack of auditing of medicines review reports and the time-intensive nature of writing medicines review reports which require ongoing pharmacist education and training that may not be readily available in healthcare systems [22].…”

Section: Discussionmentioning

confidence: 99%

What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis

Al-Diery

Freeman

Page

et al. 2023

Preprint

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Introduction Comprehensive medication management reviews are an established intervention to identify medication-related problems, such as the prescribing of potentially inappropriate medications, and under- and over-prescribing. However, the types of information included in written reports of comprehensive medication management reviews, beyond types of medication-related problems, are unknown. This study aimed to explore the types of information Australian pharmacists include in their written reports following comprehensive medication management reviews. Methods Australian consultant pharmacists were invited to upload their 10 most recent written reports of their domiciliary-based comprehensive medication management reviews. A random selection of the reports, stratified by each pharmacist, were included for qualitative content analysis. Results Seventy-two de-identified reports from eight consultant pharmacists were included for analysis. From the evaluated reports, four major categories of information were identified: 1) consumer details such as date of interview (n = 72, 100%) and medicine history (n = 70, 97%); 2) pharmacist assessment including assessment of the consumer (n = 70, 97%), medicines management (n = 68, 94%) and medicine-related issues (n = 60, 83%); 3) pharmacist recommendations, specifically pharmacological recommendations (n = 67, 93%); and 4) consumer-centred experiences such as perspective on medicines (n = 56, 78%). Reporting of consumer-centred experiences appeared most variably in the included reports, including consumer concerns (n = 38, 53%), willingness for change (n = 27, 38%), consumer preferences (n = 13, 18%), and consumer goals (n = 7, 10%). Conclusion Pharmacists within our study included a wide variety of information in their comprehensive medication management review reports. Aside from medication-related problems, pharmacists commonly provided a holistic assessment of the consumers they care for. However, despite the breadth of information included in a comprehensive medication management review report, our study suggests that there is wide variability across reports, which has the potential to impact consistent service delivery.

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“…11,16 This process, with its emphasis on shared decision-making and patient-centered care, now forms the basis of several interventions implemented internationally, with large-scale trials (both ongoing and completed) in Canada, Australia, and New Zealand. [17][18][19] The pathway platform has been made available for use in routine care; implementation as part of routine care is being trialed in community and long-term care settings. 19…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19] The pathway platform has been made available for use in routine care; implementation as part of routine care is being trialed in community and long-term care settings. 19…”

Section: Discussionmentioning

confidence: 99%

Linking Patients’ Goals and Priorities to Recommendations for Medication Changes in a Polypharmacy-Focused Structured Clinical Pathway

Mangin

Lamarche

Freeman

et al. 2023

Journal of Patient Experience

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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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Deprescribing for older people living in residential aged care facilities: Pharmacist recommendations, doctor acceptance and implementation

Cited by 15 publications

References 51 publications

The Barriers to Deprescription in Older Patients: A Survey of Spanish Clinicians

The Barriers to Deprescription in Older Patients: A Survey of Spanish Clinicians

What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis

Linking Patients’ Goals and Priorities to Recommendations for Medication Changes in a Polypharmacy-Focused Structured Clinical Pathway

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