2023
DOI: 10.1111/joim.13599
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Implementation considerations of deprescribing interventions: A scoping review

Abstract: Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescri… Show more

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Cited by 8 publications
(12 citation statements)
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“…Prescribers, HHC clinicians, and family caregivers should pay attention to inappropriate use of antipsychotics, regularly monitor patient symptoms and potential side effects on outcomes. Serving over 3.3 million Medicare beneficiaries every year, 34,35 HHC is a leading provider of home‐based care for older adults, 36 including home medication review and reconciliation, 19,37 making them an invaluable source for identifying antipsychotic use. Moreover, HHC clinicians should play a bigger role in deprescribing antipsychotics as they can help meet the underlying needs that cause BPSD, 14 such as by assessing and managing pain, 38,39 monitoring symptom changes in medical conditions, 40 removing stressors in the home (e.g., noise, temperature, light), and educating the patients and caregivers, as well as providing social contact.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…Prescribers, HHC clinicians, and family caregivers should pay attention to inappropriate use of antipsychotics, regularly monitor patient symptoms and potential side effects on outcomes. Serving over 3.3 million Medicare beneficiaries every year, 34,35 HHC is a leading provider of home‐based care for older adults, 36 including home medication review and reconciliation, 19,37 making them an invaluable source for identifying antipsychotic use. Moreover, HHC clinicians should play a bigger role in deprescribing antipsychotics as they can help meet the underlying needs that cause BPSD, 14 such as by assessing and managing pain, 38,39 monitoring symptom changes in medical conditions, 40 removing stressors in the home (e.g., noise, temperature, light), and educating the patients and caregivers, as well as providing social contact.…”
Section: Discussionmentioning
confidence: 99%
“…HHC nurses typically start by reviewing the patient's written prescriptions (scheduled and pro‐re‐nata) from the referring provider (e.g., the prescription list upon hospital discharge or from the primary care provider). The patient's home is then visually inspected to identify medications not listed on the prescription list, such as over‐the‐counter drugs, nutritional supplements, and prescriptions from other providers 19 . Once every medicine has been identified, HHC nurses ask the patient/caregiver if the patient takes it regularly (e.g., more than 1 day a week).…”
Section: Methodsmentioning
confidence: 99%
“…Although it is clear that all barriers, in one way or another, can influence the deprescription process, the appearance of certain barriers in the process affects the feasibility of implementing this activity [ 15 ]. The difficulty of modifying prescriptions made by other professionals and the resistance to withdrawal by the patient or caregiver are related to the degree of acceptance of the recommendations by the clinician, a variable highly evaluated in feasibility studies [ 17 , 18 , 19 ].…”
Section: Discussionmentioning
confidence: 99%
“…The National Institute for Health and Care Excellence (NICE) recommends deprescribing as part of the comprehensive medication review of a person with multiple long-term conditions 16–18. While appropriate deprescribing is usually commended and may be cautiously undertaken to good effect,15 there is a lack of information about how to implement it safely and appropriately 19. Recommendations overlook the specific contextual factors and various stakeholder views of care homes 20.…”
Section: Introductionmentioning
confidence: 99%
“…Considering these findings, the present study investigated the process of implementing deprescribing and these contextual factors in English care homes, including the roles and relationships of different stakeholders, which influence it. Furthermore, implementation activities of deprescribing in care homes are typically not well described and poorly understood 19 31. A better understanding of how contextual factors facilitate or hinder deprescribing, informed by an implementation framework, is needed to support the translation of deprescribing recommendations into practice 32 33…”
Section: Introductionmentioning
confidence: 99%