Un modelo de deprescripción prudente

Hortal-Carmona, Joaquín; Cruz, Iván Aguilar; Ruiz, Francisco Parrilla

doi:10.1016/j.medcli.2014.02.026

Cited by 16 publications

(3 citation statements)

References 36 publications

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“…In terms of barriers and facilitators, good communication between healthcare professionals was as a key element for success in the deprescription processes, with these elements being similar to those described in other areas [49]. In the same way, interventions designed to promote the rational use of medicines should provide information about the risk-benefit ratio, considering the possibility that the resultant risks exceed the potential benefits [50,51].…”

Section: Discussionmentioning

confidence: 97%

Evidence for deprescription in primary care through an umbrella review

et al. 2020

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Background: There is a high prevalence of potentially inappropriate prescriptions in primary care. This is associated with more frequent adverse events, lower quality of life and more frequent visits to hospital accident & emergency departments. The aim of the present study is to summarise available evidence on the effectiveness of deprescription interventions in primary care, and to describe the barriers and enablers of the process from the point of view of patients and healthcare professionals. Methods: We designed an umbrella review which includes nine systematic reviews. More than 50% of included studies were performed with adults in primary care. Two reviewers independently performed data extraction and analysis. Results: In considering studies of the effectiveness of interventions, it can be observed that the educational component of deprescription procedures is a key factor, whilst procedures tailored towards the patient's situation offer better results. With regards to studies involving healthcare professionals, the main explored areas were the balance between risks and benefits, and the need to improve communication with patients as well as other colleagues involved in patient care. Amongst the identified barriers we found lack of time, inability to access all information, being stuck in a routine, resistance to change and a lack of willingness to question the prescription decisions made by healthcare colleagues. With regards to patients, it is clear that they have worries and doubts. In order to overcome these issues, a good relationship with healthcare professionals and receipt of their support is required during the process. Conclusions: Optimizing medication through targeted deprescribing is an important part of managing chronic conditions, avoiding adverse effects and improving outcomes. The majority of deprescription interventions in primary care are effective. Good communication between healthcare professionals is a key element for success in the deprescription process.

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Section: Discussionmentioning

confidence: 97%

Evidence for deprescription in primary care through an umbrella review

et al. 2020

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“…Yet another reason put forth for the lack of emphasis on deprescription is the absence of incentives for health care personnel to reassess prescriptions and withdraw those with a negative or neutral risk/benefit. [ 4 ]…”

Section: Why Is This Deprescribing Process Gaining Momentum Albeit Amentioning

confidence: 99%

Deprescription: The prescription metabolism

Sivagnanam¹

2016

Journal of Pharmacology and Pharmacotherapeutics

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Deprescribing is a structured approach to drug discontinuation. An alternative suggested term is “prescription metabolism.” The major aim of deprescription is to purge the drug(s) considered unwanted in a given patient, especially in the elderly patients with multiple comorbidities or in those suffering from chronic disease. Like drug metabolism, prescription metabolism is a way of eliminating unwanted, troublesome, or cost-ineffective medications. The removal of such drugs has been found to decrease the incidence of adverse drug reactions and improves the rate of medication adherence, thereby reducing the economic burden on the patient as well as on the health care providers. Certain categories of drugs are to be tapered rather than abruptly stopped. Despite the availability of many tools to minimize drug therapy-related problems, there is little guidance for the process of deprescribing in general clinical practice. Various methods to reduce the risks of polypharmacy include patient education, physician education, and regulatory intervention. The suggested S and S approach (seek and screen, save and severe, sensitize and supervise) may be tried for deprescribing in general practice. More research on deprescribing is the need of the hour in almost all branches of clinical medicine which may pave the way for the betterment of health care.

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“…La conciliación del tratamiento consiste en comparar la medicación habitual con la prescrita después de una consulta médica o ingreso hospitalario, con el objetivo de analizar y resolver las discrepancias detectadas y así asegurarse que están prescritos a la dosis, vía de administración y frecuencia apropiada y que son adecuados y seguros para la situación del paciente 11 . Aunque no existe unanimidad12, 13, 14, 15 en quién debe llevar a cabo esta tarea, que es una decisión compartida, creemos que es inexcusable realizarla desde atención primaria, dado que el médico de familia, junto a enfermería, son el personal sanitario que mejor conoce la situación clínica, el contexto y el entorno sociofamiliar de cada paciente.…”

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Deprescribiendo para mejorar la salud de las personas o cuando deprescribir puede ser la mejor medicina

Jiménez¹,

Aniés²,

Vicens³

et al. 2018

Atención Primaria

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ResumenLa creciente longevidad de la población, el aumento de la morbilidad y del consumo de medicamentos han provocado que la polimedicación sea un problema de salud prioritario por sus consecuencias en el incremento de efectos adversos, interacciones farmacológicas y favorecer el deterioro funcional del paciente.La situación clínica de los pacientes cambia a lo largo del tiempo y es preciso ajustar la medicación en cada etapa, valorando la fragilidad, el nivel de dependencia y el deterioro funcional.La labor de deprescribir es compleja y requiere una adecuada formación clínica y farmacológica. En atención primaria reside el mayor conocimiento del paciente y su entorno, y de forma compartida con el paciente y cuidadores se debe valorar qué medicamentos mantener y cuáles retirar desde una perspectiva clínica, ética y social.Existen herramientas de ayuda a la deprescripción que pueden resultar útiles para el médico de familia para facilitar este proceso y que se detallan en este artículo.

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Un modelo de deprescripción prudente

Cited by 16 publications

References 36 publications

Evidence for deprescription in primary care through an umbrella review

Evidence for deprescription in primary care through an umbrella review

Deprescription: The prescription metabolism

Deprescribiendo para mejorar la salud de las personas o cuando deprescribir puede ser la mejor medicina

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