Deprescribing: a primary care perspective
TLDR
The issue of deprescribing from the perspective of primary care, the process of supervised withdrawal of an inappropriate medication and the potential to reduce some of the problems associated with polypharmacy is examined.Abstract:
Polypharmacy is an increasing and global issue affecting primary care. Although sometimes appropriate, polypharmacy can also be problematic, leading to a range of adverse consequences. Deprescribing is the process of supervised withdrawal of an inappropriate medication and has the potential to reduce some of the problems associated with polypharmacy. It is a complex and sensitive process. We examine the issue of deprescribing from the perspective of primary care. Key steps in the deprescribing process are a review of medications and corresponding indications, consideration of harms, assessment of eligibility for discontinuation, prioritisation of medications and implementation of a stopping plan with appropriate monitoring. Patient involvement is a key feature of this process. Deprescribing should be considered in the context of end-of-life care and medication safety, but approaches are also required to identify other situations where deprescribing is appropriate. General practitioners are well positioned to facilitate deprescribing, usually through formal medication review, with decisions informed by a range of other healthcare professionals. Guidelines are available that help guide these processes. A range of studies have explored attitudes towards deprescribing; patients are generally supportive of the concept, although clinician views are varied. The successful implementation of deprescribing strategies still requires important patient and clinician barriers to be overcome, and clinical trial evidence of effectiveness and safety is essential.read more
Citations
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Journal ArticleDOI
Barriers and facilitators to deprescribing in primary care: a systematic review
Alison Doherty,Paul Boland,Janet Reed,Andrew Clegg,Anne-Marie Stephani,Nefyn Williams,Beth Shaw,Lynn Hedgecoe,Ruaraidh Hill,Lauren Walker +9 more
TL;DR: A whole systems, patient-centred approach to safe deprescribing interventions is required, involving key decision-makers, healthcare professionals, patients, and carers.
Journal ArticleDOI
General practitioners' insight into deprescribing for the multimorbid older individual: a qualitative study.
TL;DR: The majority of older people with chronic diseases are prescribed multiple medicines resulting in polypharmacy, and the extrapolation of the ‘single disease model’ represented by disease‐specific guidelines is a major driver for polyphARMacy.
Journal ArticleDOI
Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care.
TL;DR: Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input, and medicines were rarely stopped or reduced.
Journal ArticleDOI
The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population - Public Health Implications
Sayeeda Rahman,Keerti Singh,Sameer Dhingra,Jaykaran Charan,Paras Sharma,Salequl Islam,Dilshad Jahan,Katia Iskandar,Nandeeta Samad,Mainul Haque +9 more
TL;DR: This review explains the public health implications associated with polypharmacy on the geriatric population with pre-existing co-morbidities during the COVID-19 pandemic and how adherence to the guidelines and recommendations of WHO, CDC, and other national/regional/international agencies can reduce the risks of SARS-CoV-2 infection.
Journal Article
Deprescribing: A simple method for reducing polypharmacy.
TL;DR: This 4-step plan will help you safely deprescribe in older adults to protect against adverse drug events and reduce functional capacity.
References
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Journal ArticleDOI
STOPP/START criteria for potentially inappropriate prescribing in older people: version 2
TL;DR: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people based on an up-to-date literature review and consensus validation among a European panel of experts.
American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
TL;DR: The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care and should lead to closer monitoring of drug use in older adults.
Journal ArticleDOI
Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications
TL;DR: This review focuses on the main age-related physiological changes affecting different organ systems and their implications for pharmacokinetics and pharmacodynamics of drugs.
Journal ArticleDOI
Reducing Inappropriate Polypharmacy: The Process of Deprescribing
Ian A Scott,Ian A Scott,Sarah N. Hilmer,Sarah N. Hilmer,Emily Reeve,Emily Reeve,Kathleen N. Potter,David G. Le Couteur,Debbie Rigby,Debbie Rigby,Danijela Gnjidic,Chris Del Mar,Elizabeth E. Roughead,Amy Page,Jesse Jansen,Jennifer H. Martin +15 more
TL;DR: A deprescribing protocol is proposed comprising 5 steps: ascertain all drugs the patient is currently taking and the reasons for each one, and prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes.
Journal ArticleDOI
Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States
Dima M. Qato,G. Caleb Alexander,G. Caleb Alexander,Rena M. Conti,Michael Johnson,Phil Schumm,Stacy Tessler Lindau +6 more
TL;DR: In this sample of community-dwelling older adults, prescription and nonprescription medications were commonly used together, with nearly 1 in 25 individuals potentially at risk for a major drug-drug interaction.