Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care.

Autor: Langford AV; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: aili.langford@monash.edu., Bero L; School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, University of Colorado Anschutz Medical Center, Denver, CO, USA., Lin CC; Faculty of Medicine and Health, School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia; Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia., Blyth FM; Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia., Doctor JN; Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA., Holliday S; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia., Jeon YH; Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia., Moullin JC; School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia., Murnion B; Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia., Nielsen S; Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia., Penm J; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia; Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia., Reeve E; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia., Reid S; Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia., Wale J; Independent Consumer Representative, Melbourne, Victoria, Australia., Osman R; NPS MedicineWise, Sydney, New South Wales, Australia., Gnjidic D; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia., Schneider CR; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: Journal of clinical epidemiology [J Clin Epidemiol] 2024 Jan; Vol. 165, pp. 111204. Date of Electronic Publication: 2023 Nov 04.
DOI: 10.1016/j.jclinepi.2023.10.020
Abstrakt: Objectives: To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics.
Study Design and Setting: Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience.
Results: The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four 'conditional' recommendations.
Conclusion: The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
Competing Interests: Declaration of competing interest Dr Reeve receives royalties from UpToDate (Wolters Kluwer) for writing a chapter on deprescribing. Professor Nielsen has received untied educational grants from Seqirus to study prescription opioid poisoning and was a named investigator on a buprenorphine depot implementation trial funded by Indivior, both unrelated to this work. Dr Holliday received an honorarium for two presentations from Indivior unrelated to this work. The University of Colorado receives remuneration for Professor Bero's work as Senior Research Integrity Editor for Cochrane. This is not related to the current work.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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