Knowing How to Stop: Ceasing Prescribing When the Medicine Is No Longer Required

Ostini, Remo; Hegney, Desley; Jackson, Claire; Tett, S. E.

doi:10.18553/jmcp.2012.18.1.68

Cited by 25 publications

(29 citation statements)

References 49 publications

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“…As described in the recent systematic review by Ostini et al (2012), there is a paucity of research assessing methods to cease prescribing even when the prescribed regimen can be unsafe. 24 The authors of the systematic review identified 12 high-quality studies, of which none evaluated a PA policy.…”

Section: ■■ Discussionmentioning

confidence: 99%

Section: ■■ Discussionmentioning

confidence: 99%

“…24 The authors of the systematic review identified 12 high-quality studies, of which none evaluated a PA policy. 24 The present study, which assessed a PA policy implemented to improve medication safety through avoidance of documented to 59 individuals not exposed to concurrent insulin or nitrate therapy in the intervention group. Using the baseline nitrate and insulin utilization patterns from Table 2, without the policy, 11 (17.9% of 59) intervention group individuals would have been exposed to concurrent rosiglitazone and nitrates, and 48 individuals (82.1% of 59) would have been exposed to concurrent rosiglitazone and insulin.…”

Section: ■■ Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Rosiglitazone Prior Authorization Safety Policy: A Cohort Study

Starner¹,

Fenrick²,

Coleman³

et al. 2012

JMCP

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Section: ■■ Discussionmentioning

confidence: 99%

Section: ■■ Discussionmentioning

confidence: 99%

Section: ■■ Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rosiglitazone Prior Authorization Safety Policy: A Cohort Study

Starner¹,

Fenrick²,

Coleman³

et al. 2012

JMCP

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“…The most common words were medication (47), deprescribing (42), patient (19), and process (15). The terms withdraw, cease, discontinue and stop (and grouped stemmed words) occurred a total of 55 times, with withdrawal the most common (14). Other words related to the qualitative analysis of characteristics identified included inappropriate (10), unnecessary (5) and plan (7) (see Figure 2).…”

Section: Word Frequencymentioning

confidence: 99%

“…However, the high prevalence of polypharmacy and PIMs and lack of guidelines for people with multi-morbidity and polypharmacy support focusing on desprescribing as a separate entity in research and practice [13][14][15]. This will require a clear and consistent definition of deprescribing.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

Reeve

Gnjidic

Long

et al. 2015

Brit J Clinical Pharma

558

415

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Aims The aim of this study was to identify what definitions have been published for the term ‘deprescribing’, and determine whether a unifying definition could be reached. A secondary aim was to uncover patterns between the published definitions which could explain any variation. Methods Systematic literature searches were performed (earliest records to February 2014) in MEDLINE, Embase, CINAHL, Informit, Scopus and Google Scholar. The terms deprescrib* or de‐prescrib* were employed as a keyword search in all fields. Conventional content analysis and word frequencies were used to identify characteristics of the definitions. Network analysis was conducted to visualize characteristic distribution across authors and articles. Results Following removal of duplicates, 231 articles were retrieved, 37 of which included a definition. Eight characteristics of the definitions were identified: use of the term stop/withdraw/cease/discontinue (35 articles), aspect of prescribing included e.g. long term therapy/inappropriate medications (n = 18), use of the term ‘process’ or ‘structured’ (n = 13), withdrawal is planned/supervised/judicious (n = 11), involving multiple steps (n = 7), includes dose reduction/substitution (n = 7), desired goals/outcomes described (n = 5) and involves tapering (n = 4). Network analysis did not reveal patterns responsible for variations in previously used definitions. Conclusions These findings show that there is lack of consensus on the definition of deprescribing. This article proposes the following definition: ‘Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’. This definition has not yet been externally validated and further work is required to develop an internationally accepted and appropriate definition.

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Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis

Disalvo

Luckett

Bennett

et al. 2020

Eur J Clin Pharmacol

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This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate.Methods: Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types.Results: Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. Conclusion:Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives, and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.

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Knowing How to Stop: Ceasing Prescribing When the Medicine Is No Longer Required

Cited by 25 publications

References 49 publications

Rosiglitazone Prior Authorization Safety Policy: A Cohort Study

Rosiglitazone Prior Authorization Safety Policy: A Cohort Study

A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis

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