Project

International Deprescribing Research Interest Group

Goal: A repository for researchers and collaborators to share descriptions of their work and information about ongoing and upcoming deprescribing initiatives. The repository will allow people to see what others are doing in the field of deprescribing and to collaborate more easily.

Please take a moment to add any applicable personal information to our research repository hosted through Google Sheets. https://docs.google.com/spreadsheets/d/1WgdgHizQLRSr7tJbAlMxinHIC3jI8XsO5GXrLSEPe7g/edit?usp=sharing

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Project log

Wade Thompson
added an update
This month, the Bruyere Deprescribing Guidelines Research Team launched their app for smart devices. The app contains the evidence-based resources that the team has been developing since 2013.
Previously only available in journals and through Deprescribing.org, the app is poised to change the way health care professionals access deprescribing resources and how they apply the tools to their practice.
But the research doesn’t stop at the app. The team is continuing efforts to rigorously assess the app’s use and quality. This information will inform an upcoming study that aiming to provide guidelines for developing effective and engaging apps for health care resources.
Check out the app for yourself and contact the deprescribing team to let them know what you think of it.
 
Frank Moriarty
added an update
Deprescribing with an interprofessional approach - what roles, competencies, and responsibilities are needed to achieve the best outcomes? New article from the Bruyère Research Institute explores these topics to ensure the most effective management of polypharmacy:
 
Wade Thompson
added 13 research items
Background: Proton pump inhibitors (PPIs) treat various upper gastrointestinal (GI) diseases. Around 50% of patients may remain on PPIs long-term without ongoing need. Eligible patients should be offered the choice of continuing their PPI or trying to reduce/stop their PPI (deprescribing), a choice dependent on values and preferences. Objectives: Our objective was to systematically scope the available evidence on patient values and preferences surrounding continued PPI treatment and/or the decision to try a reduction in their PPI. We searched the MEDLINE, Embase, and Cochrane Library databases and the grey literature as of 9 August 2016 for studies of any design examining patient values and preferences toward PPI treatment and/or deprescribing. We included patients aged ≥18 years taking PPIs for upper GI diseases. Results: We located 12 eligible studies (seven surveys, four qualitative studies, one randomized controlled trial). One study only examined values and preferences towards reducing PPI use, five studies looked only at PPI treatment (initiation/continuation), four studies assessed both PPI treatment and reduction, and two studies evaluated PPI treatment and switching (to alternative PPIs). Patients value symptom control highly and worry about symptoms returning if the PPI is reduced. They are encouraged to consider reducing their PPI if a clinician provides advice and education. All five studies that examined reducing PPI use suggest patients should understand the rationale for considering continuation versus deprescribing of PPIs and should know what to expect from deprescribing. Patients are encouraged by knowing they can return to their previous dose if necessary. Our results were limited by the small sizes of studies and the heterogeneous populations. Conclusion: Patients are willing to discuss the option of continuing PPI use or trying to reduce their PPI; however, a range of attitudes exist. The results suggest that reducing a PPI is a preference-sensitive decision. Therefore, patient attitudes should be elicited and incorporated into shared decision making surrounding the decision to continue or try deprescribing a PPI, and structured tools will be helpful to encourage this.
Deprescribing can be defined as the process of withdrawal or dose reduction of medications which are considered inappropriate in an individual. The aim of this narrative review is to provide an overview of "deprescribing"; firstly discussing the potential benefits and harms followed by the barriers to and enablers of deprescribing. We also provide practical recommendations to recognise opportunities and strategies for deprescribing in practice. Studies focused on minimizing polypharmacy indicate that deprescribing may be associated with potential benefits including resolution of adverse drug reactions, improved quality of life and medication adherence and a reduction in drug costs. While the data on the benefits is inconsistent, deprescribing appears to be safe. There are, however, potential harms including return of medical conditions or symptoms and adverse drug withdrawal reactions which emphasise the need for the process to be supervised and monitored by a health care professional. Taking action on deprescribing can be facilitated by knowledge of potential barriers, implementing a deprescribing process (utilising developed tools and resources) and identifying opportunities for deprescribing through engaging with patients and caregivers and other health care professionals and considering deprescribing in a variety of populations. Important areas for future research include the suitability of deprescribing of certain medications in specific populations, how to implement deprescribing processes into clinical care in a feasible and cost effective manner and how to engage consumers throughout the process to achieve positive health and quality of life outcomes.
Objective To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. Methods The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated from a Cochrane systematic review of antipsychotic deprescribing trials for the behavioural and psychological symptoms of dementia, and a systematic review was conducted to assess the evidence behind the benefits of using antipsychotics for insomnia. A review of reviews of the harms of continued antipsychotic use was performed, as well as narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality-of-evidence ratings were used to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. Recommendations We recommend deprescribing antipsychotics for adults with behavioural and psychological symptoms of dementia treated for at least 3 months (symptoms stabilized or no response to an adequate trial) and for adults with primary insomnia treated for any duration or secondary insomnia in which underlying comorbidities are managed. A decision-support algorithm was developed to accompany the guideline. Conclusion Antipsychotics are associated with harms and can be safely tapered. Patients and caregivers might be more amenable to deprescribing if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice or management. This guideline provides recommendations for making decisions about when and how to reduce the dose of or stop antipsychotics. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients and families.
Barbara Farrell
added a project goal
A repository for researchers and collaborators to share descriptions of their work and information about ongoing and upcoming deprescribing initiatives. The repository will allow people to see what others are doing in the field of deprescribing and to collaborate more easily.
Please take a moment to add any applicable personal information to our research repository hosted through Google Sheets. https://docs.google.com/spreadsheets/d/1WgdgHizQLRSr7tJbAlMxinHIC3jI8XsO5GXrLSEPe7g/edit?usp=sharing