Identification of behaviour change techniques in deprescribing interventions: a systematic review and meta‐analysis

Hansen, Christina Raae; O’Mahony, Denis; Kearney, Patricia M.; Sahm, Laura J.; Cullinan, Shane; Huibers, Corlina Johanna Alida; Thevelin, Stefanie; Rutjes, Anne W S; Knol, Wilma; Streit, Sven; Byrne, Stephen

doi:10.1111/bcp.13742

Cited by 57 publications

(79 citation statements)

References 59 publications

(172 reference statements)

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“…Deprescribing may be an optimal way to reduce existing PIMs in the older population . Indeed, deprescribing interventions are reported to be an effective and safe way to reduce the number of medications and thus inappropriate prescribing . In addition, to be successful, deprescribing interventions require shared decision making between patients and prescribers .…”

Section: Discussionmentioning

confidence: 99%

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Roux

Sirois

Simard

et al. 2020

Brit J Clinical Pharma

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Aims: To assess the 1-year persistence of potentially inappropriate medication (PIM) use and identify associated factors in community-dwelling older adults in Quebec, Canada.Methods: A population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System. Individuals insured by the public drug plan and aged ≥66 years who initiated a PIM between 1 April 2014 and 31 March 2015 were followed-up for 1 year. PIMs were identified using the 2015 Beers criteria. One-year persistence of PIM use was defined as continuous treatment with any PIM, without interruption for more than 60 days between prescriptions refills.Poisson regression models were performed to identify factors associated with 1-year persistence of any PIM.Results: In total, 25.1% of PIM initiators were persistent at 1 year. In non-persistent individuals, the median time to PIM discontinuation was 31 days (interquartile range 21-92). Individuals were more persistent at 1 year with antipsychotics (43.9%), longduration sulphonylureas (40.2%), antiarrhythmics/immediate-release nifedipine (36.5%) and proton pump inhibitors (36.0%). Factors significantly associated with persistence were an increased age, being a man and having a high number of medications and chronic diseases, especially dementia, diabetes and cardiovascular diseases. Conclusions:One-quarter of community-dwelling older adults are continuously exposed to PIMs. To optimize medication prescribing in the older population, further interventions are needed to limit the use of PIMs most likely to be continued, especially in individuals most at risk of being persistent and also particularly vulnerable to adverse events.

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Section: Discussionmentioning

confidence: 99%

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Roux

Sirois

Simard

et al. 2020

Brit J Clinical Pharma

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“…The most frequent medication class at discharge was statins (prescribed to 44.7% of patients), followed by alpha-1 blockers (43.7%), proton pump inhibitors (42.1%), opioids (39.8%), and beta-blockers (36.9%) (Figure 2a). These percentages correspond to large numbers of patients on statins (37,072), alpha blockers (36,243), proton pump inhibitors (34,916), opioids (32,759) and beta blockers (30,603).…”

Section: Sample and Medications At Admission And Dischargementioning

confidence: 99%

Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months

Nguyen

Jackson²,

Naugler

2020

Geriatrics

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Polypharmacy with “potentially inappropriate medications” (PIMs) and “potential prescribing omissions” (PPOs) are frequent among those 65 and older. We assessed PIMs and PPOs in a retrospective study of 82,935 patients ≥ 65 during their first admission in the period March 2013 through February 2018 to the four acute-care Calgary hospitals. We used the American Geriatric Society (AGS) and STOPP/START criteria to assess PIMs and PPOs. We computed odds ratios (ORs) for key outcomes of concern to patients, their families, and physicians, namely readmission and/or mortality within six months of discharge, and controlled for age, sex, numbers of medications, PIMs, and PPOs. For readmission, the adjusted OR for number of medications was 1.09 (1.09–1.09), for AGS PIMs 1.14 (1.13–1.14), for STOPP PIMs 1.15 (1.14–1.15), for START PPOs 1.04 (1.02–1.06), and for START PPOs correctly prescribed 1.16 (1.14–1.17). For mortality within 6 months of discharge, the adjusted OR for the number of medications was 1.02 (1.01–1.02), for STOPP PIMs 1.07 (1.06–1.08), for AGS PIMs 1.11 (1.10–1.12), for START PPOs 1.31 (1.27–1.34), and for START PPOs correctly prescribed 0.97 (0.94–0.99). Algorithm rule mining identified an 8.772 higher likelihood of mortality with the combination of STOPP medications of duplicate drugs from the same class, neuroleptics, and strong opioids compared to a random relationship, and a 2.358 higher likelihood of readmission for this same set of medications. Detailed discussions between patients, physicians, and pharmacists are needed to improve these outcomes.

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“…Challenges associated with deprescribing include how it is de ned, whether it is safe, and how these aspects are communicated to patients and health care professionals alike [37]. This re ects a desire to adopt a holistic approach to medicines optimisation, whereby patient perspectives and values are central to the consultation process, teams are inherently multidisciplinary, and where the general perspectives as well as complexities of individual cases can be addressed [38][39][40].…”

Section: Discussionmentioning

confidence: 99%

A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation

Fellenor

Britten

Courtenay

et al. 2020

Preprint

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Background Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. The purpose of this exercise was to co-produce a prioritised research agenda for medicines optimisation using a multi-stakeholder (patient, researcher, public and health professionals) approach. Methods A three-stage, multiple method process was used including: generation of preliminary research questions (Stage 1) using a modified Nominal Group Technique; electronic consultation and ranking with a wider multi-stakeholder group (Stage 2); a face-to-face, one-day consensus meeting involving representatives from all stakeholder groups (Stage 3). Results In total, 92 research questions were identified during Stages 1 and 2 and ranked in order of priority during stage 3. Questions were categorised into four areas: ‘Patient Concerns’ [e.g. is there a shared decision (with patients) about using each medicine?], ‘Polypharmacy’ [e.g. how to design health services to cope with the challenge of multiple medicines use?], ‘Non-Medical Prescribing’ [e.g. how can the contribution of non-medical prescribers be optimised in primary care?], and ‘Deprescribing’ [e.g. what support is needed by prescribers to deprescribe?]. A significant number of the 92 questions were generated by Patient and Public Involvement representatives, which demonstrates the importance of including this stakeholder group when identifying research priorities. Conclusions A wide range of research questions was generated reflecting concerns which affect patients, practitioners, the health service, as well the ethical and philosophical aspects of the prescribing and deprescribing of medicines. These questions should be used to set future research agendas and funding commissions.

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Identification of behaviour change techniques in deprescribing interventions: a systematic review and meta‐analysis

Cited by 57 publications

References 59 publications

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months

A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation

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