Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons
| Autor: | Roxana De las Salas, Javier Eslava-Schmalbach, Claudia Vaca-González, Dolores Rodríguez, Albert Figueras |
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| Rok vydání: | 2020 |
| Předmět: |
Delphi Technique
mesh:Geriatricians pharmacists Delphi method lcsh:RS1-441 Pharmaceutical Science Inappropriate Prescribing Pharmacy validation studies as topic Validation Studies as Topic Pharmacists mesh:Validation Studies as Topic 030226 pharmacology & pharmacy mesh:Colombia 0302 clinical medicine Cohen's kappa Deprescriptions general practitioners mesh:Polypharmacy colombia Content validity Original Research clinical decision-making deprescriptions mesh:Algorithms Physicians Family inappropriate prescribing mesh:Physicians Family Deprescribing Psychology Algorithms medicine.medical_specialty Consensus education Clinical Decision-Making Colombia algorithms mesh:Clinical Decision-Making Likert scale lcsh:Pharmacy and materia medica 03 medical and health sciences General Practitioners Physicians mesh:Consensus medicine Family mesh:Pharmacists polypharmacy mesh:General Practitioners Polypharmacy mesh:Inappropriate Prescribing lcsh:RM1-950 Geriatricians geriatricians mesh:Delphi Technique physicians family Clinical pharmacy lcsh:Therapeutics. Pharmacology consensus Family medicine mesh:Deprescriptions delphi technique |
| Zdroj: | Pharmacy Practice Pharmacy Practice (Granada) v.18 n.4 2020 SciELO España: Revistas Científicas Españolas de Ciencias de la Salud Instituto de Salud Carlos III (ISCIII) Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona Pharmacy Practice, Vol 18, Iss 4, p 2033 (2020) SciELO España. Revistas Científicas Españolas de Ciencias de la Salud instname |
| ISSN: | 1885-642X 1101-7775 |
| Popis: | Funding: The deprescribing tool was supported by Colciencias contract (110177758303 CT-792-2018) and Doctoral Fellowship Program 647-2015 The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons. We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity ratio, item-level content validity, and Fleiss' Kappa statistics was measured to establish reliability. The same voting method was used for round 2. A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0.77 (95% CI 0.60-0.93), for domains with Kappa= 0.73 (95%CI 0.60-0.86) and for decisions with Kappa= 0.97 (95%CI 0.90-1.00). This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient's and caregiver's preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons' medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice. |
| Databáze: | OpenAIRE |
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