Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

Nizet, Pierre; Evin, Adrien; Brociero, Emma; Vigneau, Caroline Victorri; Huon, Jean-François

doi:10.1186/s12877-023-04155-y

Cited by 6 publications

(2 citation statements)

References 74 publications

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“…Indeed, the literature suggests that MI is a powerful tool for BZDR deprescribing, as it is popular with healthcare professionals ( 33 ) and has been shown to be effective with other drugs such as opioids ( 34 ). A recently published review ( 35 ) described that different interventions had a positive impact as soon as they were based on patient empowerment ( 36–38 ). MI, for this purpose, is based on taking into account the ambivalence a patient may have about taking action.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

Huon,

Nizet,

Caillet

et al. 2023

Front. Med.

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BackgroundDeprescribing benzodiazepines and related drugs (BZDR) is a challenge due to a lack of time on physicians’ part, a lack of involvement of other health professionals, and the need for adapted tools. This study is based on primary care collaboration, by evaluating the effectiveness of a joint intervention between general practitioners and community pharmacists on the implementation of BZDR deprescribing in older adults.MethodsThis is a cluster randomized controlled trial in which each cluster will be formed by a physician-pharmacist pair. Within a cluster allocated to the intervention, the pharmacist will be trained in motivational interviewing (MI), and will offer the patient 3 interviews after inclusion by the physician. They will base their intervention on validated deprescribing guidelines. The pharmacist will receive methodological support during the first interviews. Interprofessional collaboration will be encouraged by writing reports for the physician after each interview. The following implementation outcomes will be evaluated: acceptability/adoption, appropriateness, cost, and fidelity. They will be measured by means of sociological interviews, observations, logbooks, and cost-utility analysis. Focus groups with physicians and pharmacists will be carried out to identify levers and barriers experienced in this collaboration. Observations will be conducted with pharmacists to assess their approach of the MIs. Effectiveness outcomes will be based on medication (discontinuation or reduction of BZDR) and clinical outcomes (such as quality of life, insomnia or anxiety), assessed by health insurance databases and validated questionnaires.DiscussionThis study will determine whether collaboration in primary care between physicians and pharmacists, as well as training and coaching of pharmacists in motivational interviewing, allows the implementation of BZDR deprescribing in the older adults.This study will provide an understanding of the processes used to implement deprescribing guidelines, and the contribution of collaborative practice in implementing BZDR discontinuation. The cluster methodology will allow to assess the experience of the relationship between the different primary care actors, and the related obstacles and levers.The results obtained will make it possible to produce guidelines on the involvement of community pharmacists in the management of substance abuse in older adults, or even to legislate new missions or care pathways.Clinical trial registrationClinicalTrials.gov, identifier, NCT05765656.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

Huon,

Nizet,

Caillet

et al. 2023

Front. Med.

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“…We located a total of 56 articles in the Medline database (search through PubMed), and after screening each one's title and abstract excluded 46 articles based on the previously established inclusion and exclusion criteria. The complete manuscripts of all 15 potentially relevant articles were obtained for final evaluation, among which 12 provided a response to our research objective (table 1), with (Ali et al, 2020;Mejías-Trueba et al, 2022;Nizet et al, 2023) being excluded.…”

Section: Deprescribing and Its Application In The Elderly Populationmentioning

confidence: 99%

When Less Is More: The Role of Deprescribing in the Elderly - A Narrative Review of the Evidence

Teixeira,

Guimarães,

Soares

et al. 2024

RIAGE

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The aging population is associated with an increase in elderly individuals with multimorbidity and the consequent polypharmacy. While appropriate in some cases, this often leads to the prescription of potentially inappropriate medications. Older individuals are more susceptible to adverse events due to pharmacodynamic and pharmacokinetic changes resulting from physiological alterations typical of aging, which interfere with drug metabolism. The aging process is complex, associated with multimorbidity, geriatric syndromes, functional and/or cognitive deficits, and, consequently, limited life expectancy. Currently, about 40% of the elderly are polymedicated. Deprescribing is an activeprocess of reviewing all of a patient's medications, performed by a physician, based on a risk/benefit assessment. Polypharmacy is associated with an increased risk of mortality, falls, drug interactions, and hospitalizations. The deprescribing process can lead to a reduction of about 39% in chronic medication, resulting in increased therapeutic adherence to the remaining drugs. Deprescribing is a fundamental pillar of person- centred care, and the population should be aware of its importance. A classic review was conducted through bibliographic research of systematic reviews on Medline. This narrative review aimed to address polypharmacy and its prevalence in the elderly population, evaluate the benefits and risks of deprescribing, and identify barriers and facilitating factors in the deprescribing process.

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Moving Deprescribing Beyond Potentially Harmful Medications

Lauffenburger

2024

JAMA Netw Open

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Deprescribing, or the supervised process of intentionally reducing or stopping medication, has emerged as a strategy to reduce medication overuse and mitigate risks associated with taking multiple medications. 1 Odden and colleagues 2 evaluated the association of antihypertensive deprescribing with the risk of cardiovascular events, specifically myocardial infarction (MI) and stroke, among Veterans Health Administration long-term care residents. The investigators used an observational study design and electronic health record and administrative data with a target trial emulation framework approach, which helps estimate causal effects in situations like this one in which randomized clinical trials would be difficult. Based on data from 2006 to 2019 on 13 096 adults aged 65 years or older, 18% of patients had medications deprescribed, defined as discontinuation or a 30% or greater reduction in dose; after up to 2 years of follow-up, the estimated cumulative incidence of hospitalization for MI or stroke was 11.2% in patients whose medications were deprescribed vs 8.8% in those whose medications were not (adjusted hazard ratio, 0.93; 95% CI, 0.70-1.26). Overall, the authors concluded that the adverse consequences of antihypertensive medication deprescribing, particularly major cardiovascular events, were likely to be minimal in this population.The rigorous study by Odden et al 2 challenges some conclusions of existing literature on deprescribing, which is relatively limited in terms of recency and clinical setting. 3 While low blood pressure targets less than 130/80 mm Hg (and even 120/80 mm Hg) are recommended for many patients under current guidelines, determining the right threshold for patients with complex health status, like those in long-term care settings, is less clear. The authors had access to electronic health record data to verify blood pressure values at the time of deprescribing, with median systolic and diastolic values of 127 mm Hg and 69 mm Hg, respectively, in the deprescribed group and 129 mm Hg and 70 mm Hg, respectively, in the not deprescribed group; these findings suggest that discontinuing antihypertensive medication was appropriate in these patients. While the relevance of blood pressure variability is increasingly being recognized, the relationship between this variability and long-term cardiovascular outcomes remains unclear, leaving uncertainty about how antihypertensive deprescribing should influence clinical guidelines. Patients in the study who had antihypertensives deprescribed were also taking more and different medications, raising further unanswered questions about whether certain antihypertensives may be better deprescribing targets and which patients may be most appropriate for deprescribing interventions. As mentioned by the authors, future research should also expand beyond this predominately male population of US veterans to include more diverse populations and understand whether the effects of deprescribing differ by other meaningful characteristics.The study by Odden et al ...

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Outcomes in deprescribing implementation trials and compliance with expert recommendations: a systematic review

Cited by 6 publications

References 74 publications

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

When Less Is More: The Role of Deprescribing in the Elderly - A Narrative Review of the Evidence

Moving Deprescribing Beyond Potentially Harmful Medications

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