Validated medication deprescribing instruments for patients with palliative care needs palliative care: A systematic review.

Autor:	de Andrade FK; Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil., Ignacio Nunes RP; Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil., Barboza Zanetti MO; Escuela de Enfermería de Ribeirão Preto, Universidad de São Paulo (USP), Ribeirão Preto, São Paulo, Brasil., Barboza Zanetti AC; Instituto Butantan, Universidad de São Paulo (USP), São Paulo, Brasil., Dos Santos M; Biblioteca Central, Universidad de São Paulo (USP), Ribeirão Preto, São Paulo, Brasil., de Oliveira AM; Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil. Electronic address: alanmaicondeoliveira@gmail.com., Carson-Stevens A; Centro PRIME de Gales, División de Medicina de la Población, Facultad de Medicina, Universidad de Cardiff, Cardiff, Reino Unido., Leira Pereira LR; Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil., Rossi Varallo F; Facultad de Ciencias Farmacéuticas de Ribeirão Preto, Universidad de São Paulo (USP), São Paulo, Brasil.
Jazyk:	English; Spanish; Castilian
Zdroj:	Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria [Farm Hosp] 2024 Mar-Apr; Vol. 48 (2), pp. T83-T89. Date of Electronic Publication: 2023 Nov 28.
DOI:	10.1016/j.farma.2023.08.010
Abstrakt:	Objectives: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. Results: Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear. (Copyright © 2023 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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