Evaluation of a Pharmacist-Managed Nonsteroidal Anti-Inflammatory Drugs Deprescribing Program in an Integrated Health Care System

Rashid, Rezoana; Chang, Christopher; Niu, Fang; Deguzman, Lynn; Draves, Maisha; Awsare, Sameer; Hui, Rita L.

doi:10.18553/jmcp.2020.26.7.918

Cited by 12 publications

(14 citation statements)

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“…Deprescribing of specific medications has been investigated in earlier interventions. Many of those showed positive outcomes as those targeting benzodiazepines, antidepressants, antidiabetics, anticholinergics, proton pump inhibitors, and non-steroidal anti-inflammatory medications ( Reeve et al, 2017 ; Maund et al, 2019 ; Tandun et al, 2019 ; Martinez et al, 2020 ; Rashid et al, 2020 ); while deprescribing of other medications continues to be challenging. For example, the withdrawal of urate-lowering drugs was associated with the recurrence of gout episodes ( Beslon et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

et al. 2023

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Background: Little research addressed deprescribing-focused medication optimization interventions while utilizing implementation science. This study aimed to develop a pharmacist-led medication review service with a deprescribing focus in a care facility serving patients of low income receiving medications for free in Lebanon followed by an assessment of the recommendations’ acceptance by prescribing physicians. As a secondary aim, the study evaluates the impact of this intervention on satisfaction compared to satisfaction associated with receiving routine care.Methods: The Consolidated Framework for Implementation Research (CFIR) was used to address implementation barriers and facilitators by mapping its constructs to the intervention implementation determinants at the study site. After filling medications and receiving routine pharmacy service at the facility, patients 65 years or older and taking 5 or more medications, were assigned into two groups. Both groups of patients received the intervention. Patient satisfaction was assessed right after receiving the intervention (intervention group) or just before the intervention (control group). The intervention consisted of an assessment of patient medication profiles before addressing recommendations with attending physicians at the facility. Patient satisfaction with the service was assessed using a validated translated version of the Medication Management Patient Satisfaction Survey (MMPSS). Descriptive statistics provided data on drug-related problems, the nature and the number of recommendations as well as physicians’ responses to recommendations. Independent sample t-tests were used to assess the intervention’s impact on patient satisfaction.Results: Of 157 patients meeting the inclusion criteria, 143 patients were enrolled: 72 in the control group and 71 in the experimental group. Of 143 patients, 83% presented drug-related problems (DRPs). Further, 66% of the screened DRPs met the STOPP/START criteria (77%, and 23% respectively). The intervention pharmacist provided 221 recommendations to physicians, of which 52% were to discontinue one or more medications. Patients in the intervention group showed significantly higher satisfaction compared to the ones in the control group (p < 0.001, effect size = 1.75). Of those recommendations, 30% were accepted by the physicians.Conclusion: Patients showed significantly higher satisfaction with the intervention they received compared to routine care. Future work should assess how specific CFIR constructs contribute to the outcomes of deprescribing-focused interventions.

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Section: Introductionmentioning

confidence: 99%

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

et al. 2023

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“…In addition to evaluating patient-focused outcomes, future studies should explore the unintended consequences of the interventions. Of the minority of studies that evaluated adverse events or changes in pain following NSAIDs de-implementation, none showed increases in adverse events or pain outcomes 59–63. In fact, one study reported lower pain levels among older adults who reduced NSAIDs as part of a pharmacist review programme 59…”

Section: Discussionmentioning

confidence: 99%

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings

Rockwell,

Oyese,

Singh

et al. 2024

BMJ Open

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ObjectivesPotentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) utilisation persists at undesirable rates worldwide. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in healthcare settings and to suggest directions for future research.DesignScoping review.Data sourcesPubMed, CINAHL, Embase, Cochrane Central and Google Scholar (1 January 2000 to 31 May 2022).Study selectionStudies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilisation in healthcare settings.Data extractionUsing Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilisation.ResultsFrom 7818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the USA (35.3%), with randomised controlled trial as the most common design (55.9%). Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%) but were rarely (14.9%) guided by an implementation model, framework or theory. Academic detailing, clinical decision support or electronic medical record interventions, performance reports and pharmacist review were frequent approaches employed. NSAID use was most commonly classified as potentially harmful based on patients’ age (55.8%), history of gastrointestinal disorders (47.1%), or history of kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter (OTC) NSAIDs in addition to prescription. The majority of studies (76.2%) reported a reduction in the utilisation of potentially harmful NSAIDs. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation.ConclusionMany varied interventions to de-implement potentially harmful NSAIDs have been applied in healthcare settings worldwide. Based on these findings and identified knowledge gaps, further efforts to comprehensively evaluate the effectiveness of interventions and the combination of intervention characteristics associated with effective de-implementation are needed. In addition, future work should be guided by de-implementation theory, focus on OTC NSAIDs and incorporate patient-focused strategies and outcomes, including the evaluation of unintended consequences of the intervention.

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“…• Bisphosphonates for postmenopausal women to reduce fracture risk after 19 months 32 • Cholinesterase inhibitors and memantine for Alzheimer's disease after 12 months with cognition and/or functional status worsening 33 • Nonsteroidal antiinflammatory medications (NSAIDs) if symptoms have completely resolved 34,35 • Potentially inappropriate medications 37 • Proton pump inhibitors for GERD after 4 to 8 weeks [38][39][40] • HMG-CoA reductase Inhibitors (ie, Statins) for primary prevention of cerebrovascular events after 5 to 10 years [41][42] • Stool softeners 43 Abbreviations: ADEs, adverse drug events; GERD, gastroesophageal reflux disease. medication review time and positive impact on clinical inertia, and can measure an initiative's impact directly.…”

Section: Discussionmentioning

confidence: 99%

How to implement deprescribing into clinical practice

Pruskowski

Jeffery

Brandt

et al. 2021

J Am Coll Clin Pharm

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We currently live in the age of medication overload. More than 40% of older adults (≥65 years old) are prescribed ≥5 medications a day and nearly 20% take ≥10.Although medications can provide a wide variety of benefits, the number of medications prescribed is the largest predictor of drug-drug interactions, nonadherence, and most importantly adverse drug events. Increasingly, patients, caregivers, and health care providers are employing deprescribing efforts as a solution to medication overload. Clinical pharmacists are well positioned to lead and/or contribute to deprescribing efforts. Deprescribing, however, is not commonly and consistently taught within the United States health professional curriculums, and deprescribing infrastructure support is currently limited. The goal of this review is to present a pragmatic approach to pharmacist-driven clinical practice deprescribing implementation.

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Evaluation of a Pharmacist-Managed Nonsteroidal Anti-Inflammatory Drugs Deprescribing Program in an Integrated Health Care System

Cited by 12 publications

References 14 publications

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings

How to implement deprescribing into clinical practice

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