Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines

Dumbreck, Siobhan; Flynn, Angela; Nairn, Moray; Wilson, Martin; Treweek, Shaun; Mercer, Stewart W; Alderson, Phil; Thompson, Alex; Payne, Katherine; Guthrie, Bruce

doi:10.1136/bmj.h949

Cited by 292 publications

(233 citation statements)

References 27 publications

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“…The findings of the study were published in the British Medical Journal in 2015, and the findings and figures are reported here under the terms of the Creative Commons Attribution (CC-BY) open access licence that applies, which allows free sharing and adaptation of material for any purpose. 73 …”

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Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling

Guthrie

Thompson

Dumbreck

et al. 2017

Health Serv Deliv Res

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 11/2003/27. The contractual start date was in October 2012. The final report began editorial review in July 2015 and was accepted for publication in November 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Hea...

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Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling

Guthrie

Thompson

Dumbreck

et al. 2017

Health Serv Deliv Res

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“…Guidelines do not consider complex circumstances, thus being unsuitable, because of the lack of evidence. Although recently it has begun to consider the problem of comorbidities, there are few guidelines that consider that some patients may be suffering from other concomitant diseases, and treated with further drugs 127,128 with risk of drug interactions and adverse reactions, 129,130 such as in case of multiple antihypertensive therapy. 131 We have to recognize that to date no satisfactory evidence based guidelines for complex patients are available.…”

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confidence: 99%

The FADOI (Federation of Associations of Hospital Doctors on Internal Medicine) position paper on cardiovascular prevention in the higher risk complex patients

Campanini

Pinna

Nardi³

2015

Ital J Med

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Presentation: this is not a simple matterAtherosclerosis is a chronic, multifactorial disease that affects the arteries of large and medium caliber, characterized by an intimal focal injury, protruding inside the arterial lumen and causing its progressive reThe FADOI (Federation of Associations of Hospital Doctors on Internal Medicine) position paper on cardiovascular prevention in the higher risk complex patients ABSTRACTPrevention is a very topical issue that any modern health system cannot ignore. The discussion about the concept of cardiovascular (CV) prevention is very wide and has been lasting for a long time. In this context, the research has never been stopped. A schematic classification of different types of prevention, as well as raised by the literature, implies some limitations, not always suitable to our complex patients. According to evidence-based medicine we should refer to the best available guidelines. Unfortunately the quality of evidence-based guidelines is far from optimal. The Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) faced the problem of CV prevention in the higher risk complex patients with its experts in ischemic heart disease, heart failure, stroke, chronic kidney disease, peripheral arterial disease and diabetes mellitus, by asking the following questions: i) which are the methods of risk assessment and prognostic stratification (also with respect to the existing comorbidities)?; ii) which are the tailored actions to implement for the individual patient? For the purposes of a CV risk evaluation in complex patient we cannot be satisfied with a single high baseline risk strategy: we should resize our assessment parameters to the real world, implementing a high multidimensional CV complexity risk assessment strategy, in respect of an anthropological approach to the complexity of our patients. Essentially, hospital internists are called to exercise a proactive role of experts for each single complex patient, also in CV prevention.

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“…2 In England in 2015/16, 995.3 million prescriptions were dispensed by pharmacies, an increase of 45% compared with 2006/07, and a further 84.6 million dispensed by GPs, suggesting an ever-increasing trend of polypharmacy. 3 Guidelines are a major driver for this trend but, if slavishly followed, individual patients with multimorbidity then have an increased risk of drug-drug interactions, 4 adverse drug reactions and poor adherence. These all contribute to poorer clinical outcomes.…”

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confidence: 99%

Deprescribing: tackling increasing polypharmacy

Krska¹,

Howard²,

Barnett³

2017

Prescriber

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“Deprescribing – is less more?” was the theme of this year's annual scientific meeting organised by the Prescribing and Research in Medicines Management (PRIMM) group, held in London in January. The meeting covered a range of topics relating to deprescribing, including a seven‐step deprescribing model, identifying patients with polypharmacy problems, and providing individualised prescribing.

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Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines

Cited by 292 publications

References 27 publications

Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling

Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling

The FADOI (Federation of Associations of Hospital Doctors on Internal Medicine) position paper on cardiovascular prevention in the higher risk complex patients

Deprescribing: tackling increasing polypharmacy

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