How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study

Mantelli, Sophie; Jungo, Katharina Tabea; Rozsnyai, Zsofia; Reeve, Emily; Luymes, Clare; Poortvliet, Rosalinde K. E.; Chioléro, Arnaud; Rodondi, Nicolas; Gussekloo, Jacobijn; Streit, Sven

doi:10.1186/s12875-018-0856-9

Cited by 29 publications

(36 citation statements)

References 56 publications

(65 reference statements)

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“…A mean of 6.5 drugs per patient resulted in our study. This is a significant result because this values is associated in literature with a greater risk of inappropriate prescriptions, DDI and ADR [12,13]. Belonging to the older age group (age > 85 years) was associated with the risk of polytherapy.…”

Section: Discussionmentioning

confidence: 94%

Risk of drug interactions and prescription appropriateness in elderly patients

Petrini¹,

Caviglia

Pellicano

et al. 2019

Ir J Med Sci

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Background:In Europe, adverse drug reactions and drug interactions are cause of considerable morbidity and mortality. In over 75s, hospital access due to adverse drug reactions can be as high as 1 in every 3. Aims:To assess the quality of the prescribed polytherapies in the territory, in terms of the risk of drug interactions and of prescription appropriateness, in over 75s.Methods: Randomly selected patients, over 75s, were analysed among the patients of 3 general practitioners. Their data were analysed with the INTERCheck® software. This software provided the list of drug interactions deriving from the chronic therapies. The program also provided the Beers criteria and the STOPP criteria related to the drugs, highlighting potentially inappropriate drugs.Results: 188 patients were included in the study. 216 serious or very serious drug interactions have been identified. 92 patients (48.9%) were at risk of at least one serious or very serious interaction. The cut-off of the correlation between the number of drugs taken and the risk of incurring a serious or very serious interaction was found to be 5 (AUC = 0.833, sensitivity = 87%, p < 0.001). Patients on >= 4 drugs were at risk of prescriptive inappropriateness with a sensitivity of 84% (AUC = 0.781, p < 0.0001). Conclusions:Focusing on patients with at least 4 drugs in therapy is the right strategy to reduce the risks associated with polypharmacy.

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Section: Discussionmentioning

confidence: 94%

Risk of drug interactions and prescription appropriateness in elderly patients

Petrini¹,

Caviglia

Pellicano

et al. 2019

Ir J Med Sci

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“…The characteristics of all of the included studies are described in table 1. The included studies had all been conducted in high-income developed countries, including Canada,36 37 USA,38–44 Netherlands,45 46 Australia,47 48 UK,49–51 Germany52–55 and Switzerland 56–58. Sample sizes ranged from 15 to 1169 patients and 5 to 92 clinicians in the quantitative studies, and 15 to 146 patients and 4 to 19 clinicians in the qualitative studies.…”

Section: Resultsmentioning

confidence: 99%

“…The outcome of quality assessment based on each of the aforementioned tools is summarised in online supplementary appendix 2. The majority of the quantitative studies were cross-sectional in design,36 39 40 45–47 53 54 56–58 including the quantitative elements of the two mixed-methods studies. The other studies included one cohort study44 and one randomised controlled trial 52.…”

Section: Resultsmentioning

confidence: 99%

“…The cross-sectional studies were of moderate quality, with a number of studies having small sample sizes 40 45 46 54. The sample sizes of clinicians in most of the cross-sectional studies were particularly small, ranging from of 9 to 157 clinicians,45 46 54 57 which impacts on the generalisability and application of their findings. We noted that a number of the studies did not use prevalidated questions and tools to ascertain priorities,36 54 56–58 leading to a degree of subjectivity in the way in which priorities were ascertained, and the risk of measurement bias which again impacts on the generalisability of their findings.…”

Section: Resultsmentioning

confidence: 99%

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Priorities of patients with multimorbidity and of clinicians regarding treatment and health outcomes: a systematic mixed studies review

et al. 2020

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ObjectivesTo identify studies that have investigated the health outcome and treatment priorities of patients with multimorbidity, clinicians or both, in order to assess whether the priorities of the two groups are in alignment, or whether a disparity exists between the priorities of patients with multimorbidity and clinicians.DesignSystematic review.Data sourcesMEDLINE, EMBASE, CINHAL and Cochrane databases from inception to May 2019 using a predefined search strategy, as well as reference lists containing any relevant articles, as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines.Eligibility criteriaWe included studies reporting health outcome and treatment priorities of adult patients with multimorbidity, defined as suffering from two or more chronic conditions, or of clinicians in the context of multimorbidity or both. There was no restriction by study design, and studies using quantitative and/or qualitative methodologies were included.Data synthesisWe used a narrative synthesis approach to synthesise the quantitative findings, and a meta-ethnography approach to synthesise the qualitative findings.ResultsOur search identified 24 studies for inclusion, which comprised 12 quantitative studies, 10 qualitative studies and 2 mixed-methods studies. Twelve studies reported the priorities of both patients and clinicians, 10 studies reported the priorities of patients and 2 studies reported the priorities of clinicians alone. Our findings have shown a mostly low level of agreement between the priorities of patients with multimorbidity and clinicians. We found that prioritisation by patients was mainly driven by their illness experiences, while clinicians focused on longer-term risks. Preserving functional ability emerged as a key priority for patients from across our quantitative and qualitative analyses.ConclusionRecognising that there may be a disparity in prioritisation and understanding the reasons for why this might occur, can facilitate clinicians in accurately eliciting the priorities that are most important to their patients and delivering patient-centred care.PROSPERO registration numberCRD42018076076.

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“…Nevertheless, medications, including statins, are often continued until death . It has been reported that physicians do not feel confident about deprescribing cardiovascular preventive medication and survey studies have found considerable treatment variation in the advice regarding discontinuation of preventive medication . A likely contributing factor and an acknowledged barrier to deprescribing medications is the lack of evidence and clear guidance in clinical practice guidelines .…”

mentioning

confidence: 99%

Recommendations for (Discontinuation of) Statin Treatment in Older Adults: Review of Guidelines

Ploeg

Floriani

Achterberg

et al. 2019

J American Geriatrics Society

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OBJECTIVES: As a person's age increases and his/her health status declines, new challenges arise that may lead physicians to consider deprescribing statins. We aimed to provide insight into recommendations available in international cardiovascular disease prevention guidelines regarding discontinuation of statin treatment applicable to older adults. DESIGN: We systematically searched PubMed, EMBASE, EMCARE, and the websites of guideline development organizations and online guideline repositories for cardiovascular disease prevention guidelines aimed at the general population. We selected all guidelines with recommendations (instructions and suggestions) on discontinuation of statin treatment applicable to older adults, published between January 2009 and April 2019. In addition, we performed a synthesis of information from all other recommendations for older adults regarding statin treatment. Methodological quality of the included guidelines was appraised using the appraisal of guidelines for research & evaluation II (AGREE II) instrument. RESULTS: Eighteen international guidelines for cardiovascular disease prevention in the general adult population provided recommendations for statin discontinuation that were applicable to older adults. We identified three groups of instructions for statin discontinuation related to statin intolerance, and none was specifically aimed at older adults. Three guidelines also included suggestions to consider statin discontinuation in patients with poor health status. Of the 18 guidelines included, 16 made recommendations regarding statin treatment in older adults, although details on how to implement these recommendations in practice were not provided. CONCLUSION: Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians who are considering statin discontinuation in older adults in the context of declining health status and short life expectancy. J Am Geriatr Soc 68:417-425, 2020.

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How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study

Cited by 29 publications

References 56 publications

Risk of drug interactions and prescription appropriateness in elderly patients

Risk of drug interactions and prescription appropriateness in elderly patients

Priorities of patients with multimorbidity and of clinicians regarding treatment and health outcomes: a systematic mixed studies review

Recommendations for (Discontinuation of) Statin Treatment in Older Adults: Review of Guidelines

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