China
Africa
Explore chapters and articles related to this topic
Medications
Published in Henry J. Woodford, Essential Geriatrics, 2022
As previously discussed, clinicians tend to overestimate the beneficial effects of medications, underestimate the potential harms, assume patient adherence and overlook non-drug aspects of care. To help restore balanced decisions, future clinical guidelines should include deprescribing advice.150 Deprescribing is a multi-factorial, patient-specific, time-consuming and highly skilled process. It can't be simplified to a list, guideline or algorithm alone, just as all prescribing can't. Team working between physicians, pharmacists and nurse specialists is required, including monitoring the effects of any changes.
Chronic disease prevention and management: An understated priority
Published in Bernadette N. Kumar, Esperanza Diaz, Migrant Health, 2019
Obtaining the medical history can be painstaking, with confusing timelines and medical records that are incomplete and not translated. The medications patients bring with them may be inadequate, unnecessary, or unexplained. A careful history of the course of illness including onset, investigations done, different doctors seen, and hospitalizations, is needed to piece together the story and lay down a stronger foundation on which to make clinical decisions. It is also an opportunity to inquire about access to care before leaving and along their journey. Gaps in care indicate the need for a low threshold for suspicion of unidentified complications and comorbidities. Medication adjustment and deprescribing often needs to be considered.
General principles on caring for older adults
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
When there is a major change in the patient’s general health or functional status (e.g., falls, functional decline, cognitive decline, delirium, hospitalization, institutionalization), clinicians should reassess the ongoing need for each medication and consider deprescribing medications with questionable benefit or high risk of harm. Standard checklists, such as the American Geriatrics Society Beers list (24) or STOPP/START criteria (25), can be used to identify high-risk medications. A time-limited withdrawal may help clinicians determine the need for ongoing therapy when the indication for a medication is unclear. When deprescribing cardiovascular drugs, a gradual tapering off may be necessary to reduce rebound or withdrawal symptoms.
Reducing inappropriate polypharmacy for older patients at specialist outpatient clinics: a systematic review
Published in Current Medical Research and Opinion, 2023
Louise Clarkson, Laura Hart, Alfred K. Lam, Tien K. Khoo
Specialist outpatient clinics are an additional type of setting to review for inappropriate medication use, especially for older patients who often suffer from co-morbidity and are at significant risk of polypharmacy. Deprescribing for hospital inpatients may not be an aspect of focus during acute admission and, in primary care, general practitioners might be reluctant to cease medications prescribed elsewhere. A specialist outpatient clinic provides a setting for experts to appraise medical conditions that might change the risk-benefit profile of existing medications. The evidence for deprescribing interventions in outpatient clinics is very limited; however, the addition of a pharmacist and use of validated medication assessment tools appear to be enablers. The most effective way to incorporate a deprescribing intervention has not been established and requires more research, but it might involve a multidisciplinary clinic that includes a pharmacist or a targeted pharmacist-led, physician-implemented intervention. It is also possible that the existence of a specific polypharmacy service could help to break the lack of intervention for patients with high medication burdens. Further research is warranted to confirm whether this approach is effective, the changes can be maintained, and that this approach translates to clinical benefit.
Antibiotic deprescribing: Spanish general practitioners’ views on a new strategy to reduce inappropriate use of antibiotics in primary care
Published in European Journal of General Practice, 2022
Carl Llor, Gloria Cordoba, Sandi Michele de Oliveira, Lars Bjerrum, Ana Moragas
The term ‘deprescribing’ is mainly linked to chronic diseases, as it is increasingly recognised that many adults and older people take a large number of medications, often including unnecessary or potentially inappropriate ones [15]. However, deprescribing can also be performed in acute conditions. The best way to minimise unnecessary medication use is to be judicious in prescribing medications in the first place. However, this decision might have been made by a colleague, a pharmacist, a private doctor, or even by the patients (self-prescribing), who come to our practice for reassurance. Once the therapeutic decision has been made and the patient has already taken one or a few doses of an antibiotic course, healthcare professionals must make their best judgement on the appropriateness of continuing this medication after thoroughly considering the patient’s history and clinical examination. If we assess that the antibiotic course will result in more harm than benefit, we should pursue the cessation of the therapy. We need to overcome the usual prescribing inertia that is so common in some chronic diseases but also, unfortunately, is so widespread with antimicrobial therapy [16].
Trends and concerns of potentially inappropriate medication use in patients with cardiovascular diseases
Published in Expert Opinion on Drug Safety, 2021
Nina D. Anfinogenova, Irina A. Trubacheva, Sergey V. Popov, Elena V. Efimova, Wladimir Y. Ussov
Knowing and recognizing views of patients regarding their prescriptions is effective for general practitioners while making decision on deprescription of preventive cardiovascular medications [118–120]. A family history for CVD seems to be a barrier to deprescribing in both patients and physicians. Patients anticipate unfavorable consequences and are influenced by the opinion of their general practitioner. A potential disapproving opinion from medical specialists affects the willingness of general practitioner to deprescribe. Patients value discussing their doubts regarding deprescribing preventive cardiovascular PIMs. In turn, the physician’s decision to deprescribe depends on patient’s CVD risk, risk factors, and the specialist’s opinions regarding treatments. Deprescribing consultations are recommended to be patient-centered, with a physician addressing probable consequences of deprescription [118]. Overall, CVD patients may be assigned into three categories according to their viewpoints: (1) a controlling viewpoint, where patients believe that monitoring their condition is essential; (2) an autonomous viewpoint, in which patients show a dislike of medication; and (3) an afraid viewpoint with patients fear CVD [119]. Deprescribing the preventive cardiovascular medication can be considered in low-CVD-risk patients and is safe in the short term if blood pressure and cholesterol levels are monitored after stopping [45,118–129].