Implementation considerations of deprescribing interventions: A scoping review.

Autor: Wang J; Elaine, Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA., Shen JY; Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA., Conwell Y; Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA., Podsiadly EJ; Harriet J. Kitzman Center for Research Support, School of Nursing, University of Rochester, Rochester, New York, USA., Caprio TV; Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA.; UR Medicine Home Care, University of Rochester Medical Center, Rochester, New York, USA.; University of Rochester Medical Center, Finger Lakes Geriatric Education Center, Rochester, New York, USA., Nathan K; Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA.; St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA., Yu F; Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA., Ramsdale EE; Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York, USA., Fick DM; Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, USA., Mixon AS; Department of Medicine, Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA., Simmons SF; Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA.; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA.; Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Jazyk: angličtina
Zdroj: Journal of internal medicine [J Intern Med] 2024 Apr; Vol. 295 (4), pp. 436-507. Date of Electronic Publication: 2023 Jan 09.
DOI: 10.1111/joim.13599
Abstrakt: Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health-care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health-care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high-risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health-care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.
(© 2022 The Association for the Publication of the Journal of Internal Medicine.)
Databáze: MEDLINE
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