Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis (original) (raw)
Ahmad et al.112
2010
The Netherlands
Effect of medication review and cognitive behaviour treatment by community pharmacists of patients discharged from the hospital on drug related problems and compliance: design of a randomized controlled trial
Protocol for RCT
Patients aged > 60 years discharged from general academic hospitals
To examine the effect of medication review and cognitive behaviour therapy of discharged patients by community pharmacists to minimise the occurrence of drug-related problems
Ailabouni et al.113
2016
New Zealand
General practitioners’ insight into deprescribing for the multimorbid older individual: a qualitative study
Qualitative interview study
GPs prescribing for patients living in residential care
To explore GPs’ opinions and awareness of deprescribing for a hypothetical older multimorbid patient in residential care
Akinbolade et al.114
2016
UK
Deprescribing in advanced illness
Literature review
Patients with advanced illness
To review reviews’ research on prescribing medicines to patients with advanced illness, focusing on the identification of the prevalence of inappropriate or unnecessary medicines to the initiation of the deprescribing process
Al Shemeili et al.115
2016
United Arab Emirates
An exploration of health professionals’ experiences of medicines management in elderly, hospitalised patients in Abu Dhabi
Qualitative interview study
Health-care professionals working in hospitals involved in medication management. The sample included nurses, pharmacists and doctors
To describe and understand health professionals’ views and experiences of medicines management health-care structures, processes and outcomes for elderly, hospitalised patients
Altiner et al.116
2012
Germany
Activating GENeral practitioners dialogue with patients on their Agenda (MultiCare AGENDA) study protocol for a cluster randomized controlled trial
Protocol for cluster RCT
General practice patients aged 65–84 years with at least three chronic conditions
To investigate the efficacy of a complex, multifaceted intervention aimed at increasing the quality of care of GPs for patients with multimorbidity through enhancing the doctor–patient dialogue and identifying the patient’s agenda and needs
Anderson et al.117
2017
Australia
Negotiating ‘unmeasurable harm and benefit’: perspectives of general practitioners and consultant pharmacists on deprescribing in the primary care setting
Qualitative focus group study
GPs and consultant pharmacists working in south-east Queensland
To explore GPs’ and consultant pharmacists’ views about inappropriate polypharmacy, the reasoning they apply to deprescribing in primary care and to identify factors that support or inhibit this process
Baqir et al.118
2014
UK
A clinico-ethical framework for multidisciplinary review of medication in nursing homes
Quality improvement project
Pharmacists undertaking medication reviews with nursing home residents
To optimise medicines in care homes while involving all residents in decision-making
Barnett et al.18
2016
UK
Patient-centred management of polypharmacy: a process for practice
Review
Current UK literature around polypharmacy
To provide an overview of key guidance from the UK about polypharmacy and to introduce a tool to support patient-centred practice
Bartlett Ellis and Welch119
2016
USA
Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies
Systematic review: meta-ethnography
Literature on medication-taking behaviour in chronic kidney disease
To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions
Beuscart et al.103
2018
Belgium
International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy
Mixed methods: systematic review, semistructured interviews, Delphi survey
Older patients with multimorbidity and polypharmacy
To describe a method that could be used to develop a core outcome set for use in trials of older patients with multimorbidity
Bokhof and Junius-Walker120
2016
Germany
Reducing polypharmacy from the perspectives of general practitioners and older patients: a synthesis of qualitative studies
Systematic review, meta-ethnography
GPs and older patients
To synthesise qualitative studies exploring the perspectives and experiences of GPs and older patients in reducing polypharmacy and to discover approaches already being practised
Bolmsjö et al.121
2016
Sweden and Australia
Factors influencing deprescribing for residents in advanced care facilities: insights from general practitioners in Australia and Sweden
Qualitative synthesis of two interview studies
General practitioners serving patients in long-term care facilities
To compare and contrast behavioural factors influencing the prescribing practices of GPs providing care in advanced care facilities in two different countries; to review health policy and aged care facility systems in each setting for their potential impact on the prescribing of medications; based on these findings provide recommendations
Cashman et al.122
2010
UK
The treatment of co-morbidities in older patients with metastatic cancer
Review of medical records and patient interviews
Patients with metastatic cancer
To determine whether or not older patients with metastatic cancer continue to take medications for the treatment of pre-existing comorbidities after the diagnosis of metastatic disease
Cenci123
2016
Italy
Narrative medicine and the personalisation of treatment for elderly patients
Literature review
Patients with multimorbidity and polypharmacy
To provide an overview of how narrative medicine can promote the development of a systematic, integrated and multidisciplinary approach to older patients
Centeno and Fullerton124
2016
USA
Got pills? A pharmacist’s impact on chronic disease and older adults in transitions of care
Conference abstract
Quality improvement project
To assess the impact of medication reconciliation by clinical pharmacist on patient outcomes during transitions of care
Chen and Buonanno125
2017
USA
Geriatric polypharmacy: two physicians’ personal perspectives
Opinion piece
Two clinicians discussing experiences of managing polypharmacy
To discuss geriatric polypharmacy from two practitioners’ viewpoints
Cheraghi-Sohi et al.126
2015
United Kingdom
The influence of personal communities on the self-management of medication taking: a wider exploration of medicine work
Qualitative interview study
Patients with long-term conditions
To explicate the nature of the work that people with multiple long-term conditions, and their network members, do in attempting to take their medications on a daily basis, the division of labour among these members and when and why network members become involved in that work
Christensen et al.127
2017
Denmark
Physicians’ non-uniform approach to prescribing drugs to older patients – a qualitative study
Qualitative interview study
Medical specialists working with older patients
To explore physicians’ approach to prescribing drugs to older patients, including identifying the drugs that physicians perceive to be risk drugs for older patients and comparing them with established lists of potentially inappropriate medications
Cimmino and Pisano128
2016
USA
A patient’s last wish at end-of-life
Case study
Patients at the end of life
A case study discussing managing polypharmacy at the end of life
Clyne et al.129
2016
Ireland
‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people
Qualitative interview study
GPs participating in a RCT of an intervention to decrease potentially inappropriate prescribing in older patients (aged ≥ 70 years) in Ireland
To explore GP perspectives regarding prescribing and potentially inappropriate prescribing in older primary care patients
Cullinan et al.130
2017
Ireland
Challenges of deprescribing in the multimorbid patient
Literature review
Literature on challenges to deprescribing in patients with multimorbidity
To highlight some of the potential reasons for this lack of deprescribing and the challenges to discontinuing drugs for these patients
Cullinan et al.131
2015
Ireland
Doctors’ perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study
Qualitative interview study
Hospital doctors prescribing for older people
To identify hospital doctors’ perceptions as to why potentially inappropriate prescribing occurs, to identify the barriers to addressing the issues identified and to determine which intervention types would be best suited to improving prescribing
Djatche et al.132
2017
Italy
How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing?
Survey
Primary care physicians
To assess the perceptions of primary care physicians on deprescribing for elderly patients and potential barriers to deprescribing that physicians experience in the local health authority of Parma, Emilia Romagna, Italy
Drenth-van Maanen et al.133
2017
The Netherlands
The Systematic Tool to Reduce Inappropriate Prescribing (STRIP): combining implicit and explicit prescribing tools to improve appropriate prescribing
Presentation of a prescribing tool
n/a
To describe STRIP and its ability to identify potentially inappropriate prescribing
Duncan et al.134
2017
UK
Deprescribing: a primary care perspective
Literature review
Literature on deprescribing and polypharmacy in primary care
To describe trends in polypharmacy and explanations for why it is increasing; outline the harms associated with overtreatment; outline the rationale for deprescribing and different approaches to deprescribing within general practice, including the role of the pharmacist; outline the barriers to and enablers of deprescribing; and make recommendations for future practice
Edelman et al.135
2019
The Netherlands
Patients’ attitudes towards deprescribing alpha-blockers and their willingness to participate in a discontinuation trial
Questionnaire
Men aged ≥ 30 years with lower urinary tract symptoms and who were first prescribed an alpha-blocker in 2015 or 2016
To gain insights into the attitudes of men with lower urinary tract symptoms towards deprescribing alpha-blockers and to assess their willingness to participate in a planned discontinuation trial
Elliott et al.136
2007
USA
Strategies for coping in a complex world: adherence behavior among older adults with chronic illness
Qualitative interview study
Older adults taking multiple medications
To explore how older adults with multiple illnesses make choices about medicines
Frank137
2014
Canada
Deprescribing: a new word to guide medication review
Commentary
n/a
To describe deprescribing
Fried et al.71
2017
USA
Effect of the Tool to Reduce Inappropriate Medications (TRIM) on medication communication and deprescribing
RCT
128 veterans aged ≥ 65 years prescribed seven medications, randomised to receipt of TRIM or usual care
To examine the effect of TRIM, a web tool linking the EHR to a clinical decision support system, on medication communication and prescribing
Garfinkel138
2017
Israel
Overview of current and future research and clinical directions for drug discontinuation: psychological, traditional and professional obstacles to deprescribing
Literature review/commentary
n/a
To provide an overview of, and future research and clinical directions for, drug discontinuation
Gaup and Halvorsen139
2015
Norway
Physicians’ experiences with NORGEP criteria and the use of inappropriate medication in elderly patients in nursing home and home care service
Conference abstract for qualitative interview study
Nursing home physicians and GPs
To investigate how nursing home physicians and GPs cope with inappropriate prescribing, their own experiences of using NORGEP criteria in clinical work, and how inappropriate prescribing could be reduced
Geijteman et al.140
2018
The Netherlands
Medication discontinuation at the end of life: a questionnaire study on physicians’ experiences and opinions
Questionnaire
General practitioners and clinical specialists working in three regions in the Netherlands
To explore physicians’ opinions and experiences regarding medication discontinuation during the last phase of life, and to identify factors influencing the continuation of potentially inappropriate medications
Gillespie et al.141
2018
Australia
Deprescribing for older adults in Australia: factors influencing GPs
Survey
GPs
To explore factors that influence deprescribing among Australian GPs using a new 21-item survey to measure GP attitudes and practices
Gnjidic et al.142
2012
Australia
Deprescribing trials: methods to reduce polypharmacy and the impact on prescribing and clinical outcomes
Literature review
Literature on interventions designed to reduce polypharmacy on prescribing and clinical outcomes
To highlight the evidence for the impact of various types of interventions designed to reduce polypharmacy on prescribing and clinical outcomes in older adults from community, nursing home, and hospital settings
Gnjidic et al.143
2014
Australia
Discontinuing drug treatments: we need better evidence to guide deprescribing
Commentary
n/a
To describe the evidence base for deprescribing
Gonçalves144
2018
Portugal
Deprescription in advanced cancer patients
Literature review
n/a
To describe deprescribing in cancer patients and propose a six-step method for deprescription
Hardy and Hilmer145
2011
Australia
Deprescribing in the last year of life
Literature review
n/a
To provide an algorithm to guide safe, rational deprescribing for patients who are believed to be in their last year of life
Harriman et al.146
2015
Canada
Deprescribing medication for frail elderly patients in nursing homes: a survey of Vancouver family physicians
Survey
Family physicians
To understand the beliefs and approaches of experienced FPs to help identify ways to improve current practices and reduce polypharmacy among frail elderly patients
Hasler et al.147
2015
Switzerland
Effect of a patient-centered drug review on polypharmacy in primary care patients: study protocol for a cluster-randomized controlled trial
Protocol for a cluster RCT
Primary care physicians
To determine whether or not a patient-centred systematic review leads to more appropriate medication use in patients without negatively affecting quality of life and the course of the disease
Heaton et al.32
2017
UK
Person-centred medicines optimisation policy in England: an agenda for research on polypharmacy
Review of policy, documentary analysis of reports on medicines optimisation
Policy reports on medicines optimisation published by the RPS, The King’s Fund and NICE since 2013
To examine how patient perspectives and person-centred care values have been represented in documents on medicines optimisation policy in England
Hernandez148
2017
USA
Medication management in the older adult: a narrative exploration
Qualitative interview study
Nurse practitioners caring for older adults
To characterise the meaning NPs ascribe to personal experiences of providing care to older adults who take multiple medications to manage complex conditions
Hilmer et al.149
2012
Australia
Thinking through the medication list: appropriate prescribing and deprescribing in robust and frail older patients
Literature review
n/a
To provide an ethically sound, evidence-based discussion of the benefits and harms of medications commonly used in primary care among older patients
Howland150
2012
USA
Questions to ask when selecting medication
Commentary/opinion piece
n/a
To explore eight questions that should be considered when selecting medication for a patient
Jäger et al.151
2015
Germany
Medication lists and brown bag reviews: potential positive and negative impacts on patients beliefs about their medicine
Cross-sectional study with survey
Patients aged > 50 years taking more than four drugs and enrolled into the ‘Polypharmacy in Multimorbid Patients’ study
To explore whether or not patients’ use of a medication list is associated with their beliefs about their medicine and their memory of structured medication counselling
Jansen et al.152
2017
Australia
General Practitioners’ decision-making about primary prevention of cardiovascular disease in older adults: a qualitative study
Qualitative interview study
GPs
To explore GPs’ decision-making about primary CVD prevention in patients aged ≥ 75 years
Jones153
1997
USA
Decreasing polypharmacy in clients most at risk
Commentary/opinion piece
n/a
To give an overview of decreasing polypharmacy
Kaufman et al.154
2017
UK
Considering patient experience and evidence-based choice of medicines in medicines optimisation
CPD module
n/a
To discuss the challenges of medicines optimisation, a patient-focused approach to supporting patients to gain maximum benefit from their medicines
Knowles et al.155
2017
UK
Empowering people to help speak up about safety in primary care: using co-design to involve patients and professionals in developing new interventions for patients with multimorbidity
Accelerated experience-based co-design and the future workshop approach
Health-care professionals and patients
To explore whether or not co-production methodologies could enhance intervention development and provide a mechanism to translate available evidence into patient-centred intervention proposals for multimorbidity and safety
Köberlein et al.156
2013
Germany
General practitioners’ views on polypharmacy and its consequences for patient health care
Study protocol for a retrospective cross-sectional study using mixed methods
GPs and patients
To detect the status quo of the health-care situation in Saxony’s general practices for multimorbid patients receiving multiple medications
Komagamine et al.74
2018
Japan
Characteristics of elderly patients with polypharmacy who refuse to participate in an in-hospital deprescribing intervention: a retrospective cross-sectional study
Retrospective cross-sectional study
Patients aged ≥ 65 years who reported the use of five or more medications on admission to the orthopaedic ward from January 2015 to December 2016 and who were approached by a pharmacist for polypharmacy screening
To evaluate the prevalence of PIM use in elderly patients accepting and refusing a deprescribing intervention and to investigate factors associated with deprescribing refusal
Krska157
2018
UK
Factoring in frailty when optimising medication
Opinion piece/commentary
n/a
To give advice to help identify frailty and adopt a patient-centred approach to medicines optimisation
Krska et al.158
2014
UK
Measuring the impact of long-term medicines use from the patient perspective
Commentary
n/a
To discuss measuring the impact of long-term medicines use from the patient perspective
Kuruvilla et al.159
2018
Australia
Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: a qualitative exploration of consumer and health care professional perspectives
Qualitative focus group study
Palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists
To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps
Laursen et al.160
2018
Denmark
General practitioners’ barriers towards medication reviews in polymedicated multimorbid patients: how can a focus on the pharmacotherapy in an outpatient clinic support GPs?
Qualitative interview study
GPs
To explore whether or not GPs experienced barriers towards medication reviews in polymedicated, multimorbid patients, and how a clinical pharmacologist with a focus on pharmacotherapy can support the GPs in an outpatient clinic
Maidment et al.161
2017
UK
Developing a framework for a novel multidisciplinary, multiagency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)–a realist synthesis
Protocol for a realist synthesis
Literature on medication management in older people on complex medication regimes residing in the community
To understand how, why, for whom and in what context interventions to improve medication management in older people on complex medication regimes residing in the community work
Mangin et al.14
2018
Canada
International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): position statement and 10 recommendations for action
Opinion piece
n/a
To present the first position statement of IGRIMUP on the international co-operative effort and recommendations for actions needed to prevent and counter IMUP and its drivers globally
Manias et al.162
2007
Australia
Managing complex medication regimens: perspectives of consumers with osteoarthritis and healthcare professionals
Qualitative focus group and interview study
Patients and health-care professionals
To examine medication management for osteoarthritis and other chronic conditions from the perspectives of community-dwelling consumers and health-care professionals, using a qualitative approach
Mantelli et al.163
2018
Switzerland
How general practitioners would deprescribe in frail oldest-old with polypharmacy – the LESS study
Survey
GPs
To determine whether or not, how and why Swiss GPs deprescribe for the oldest-old (aged > 80 years) with multimorbidity and polypharmacy
Marengoni et al.164
2015
Italy
Best practices for drug prescribing in older adults: a call for action
Opinion piece
n/a
To propose a multicomponent intervention with the goal of achieving the best-tailored pharmacotherapy
McCarthy et al.75
2017
Ireland
Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot
Protocol for a cluster RCT
General practice patients (aged ≥ 65 years with ≥ 15 prescribed medications) and GPs
To assess the effectiveness of a complex intervention designed to support GPs to reduce potentially inappropriate prescribing and consider deprescribing in older people with multimorbidity and significant polypharmacy in Irish primary care
McGrath et al.165
2017
USA
Deprescribing: a simple method for reducing polypharmacy
Commentary/opinion piece using a case study
n/a
To present a four-step plan to aid the safe deprescribing in older adults
Mc Namara et al.166
2017
Australia
Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia
Qualitative interview study
Health-care professionals including nurses, doctors, dentists, pharmacists and physiotherapists working in a range of settings
To explore current approaches to multimorbidity management, and perceived barriers to and enablers of delivering appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy from a broad range of health-care professional perspectives in Australia
Modig et al.167
2009
Sweden
Frail elderly patients in primary care – their medication knowledge and beliefs about prescribed medicines
Questionnaire
Patients aged ≥ 65 years with multiple illnesses
To describe elderly patients’ knowledge about and attitudes towards their medicines in Swedish primary care
Molokhia and Majeed169
2017
UK
Current and future perspectives on the management of polypharmacy
Opinion piece
n/a
To review trends in polypharmacy and how clinicians can try to ensure that they maximise the benefits of prescribing and minimise the associated complications, particularly in the increasing number of frail, elderly patients whom physicians are now seeing in health systems across the world
Mudge et al.168
2016
Australia
Impact of a pilot multidisciplinary clinic for frequent attending elderly patients on deprescribing
Retrospective study
Patients with frequent medical admissions
To examine the impact of the THRIVE model on medication count, tablet load and PIMs
Nadarajan et al.170
2018
Singapore
The attitudes and beliefs of doctors towards deprescribing medications
Survey
Hospital doctors
To explore the attitudes and beliefs of deprescribing medications among doctors in the DIM in SGH, and to see if differences exist among junior and senior doctors in their attitudes towards deprescribing
Naughton and Hayes171
2016
UK
Deprescribing in older adults: a new concept for nurses in administering medicines and as prescribers of medicine
Literature review
n/a
To examine the context of deprescribing from the perspective of nurses in medicines administration and prescribing practices and to outline the nature of the nursing contribution to this emerging topic
Ng et al.172
2017
Singapore
Deprescribing: what are the views and factors influencing this concept among patients with chronic diseases in a developed Asian community?
A cross-sectional study using the validated PATD questionnaire
Patients on regular follow-up at the clinics for chronic disease management and with at least five regular prescription medications
To elucidate patients’ attitudes towards the number of medications they were taking and identify factors that might influence acceptance of deprescription
Nixon and Vendelø173
2016
Denmark
General practitioners’ decisions about discontinuation of medication: an explorative study
Qualitative interviews and observations
GPs
To investigate how GPs’ decisions about discontinuation of medication are influenced by their institutional context
Drug and Therapeutics Bulletin174
2016
UK
Frailty, polypharmacy and deprescribing
Commentary
n/a
To provide an overview of frailty, polypharmacy and deprescribing
Oboh and Qadir175
2017
UK
Deprescribing and managing polypharmacy in frail older people: a patient-centred approach in the real world
Case report
A 73-year-old diabetic man taking multiple medications, with GI and pain symptoms as well as poor adherence to medicines
To describe a pharmacist-led, patient-centred approach to deprescribing in a 73-year-old diabetic man taking multiple medication, with GI and pain symptoms as well as poor adherence to medicines
O’Brien176
2011
Canada
Withdrawing medication managing medical comorbidities near the end of life
Case report
A 67-year-old woman with a long smoking history, presenting with dyspnoea, cough with haemoptysis, fatigue, and weight loss, as well as low back and left hip pain
To discuss withdrawing medication in a patient with multimorbidity near the end of life
Ouellet et al.177
2018
USA
Principle of rational prescribing and deprescribing in older adults with multiple chronic conditions
Literature review
n/a
To provide a reasoned approach to medication prescribing and deprescribing decisions for older adults with multiple chronic conditions, which aims to achieve clinical outcomes that matter most to each individual patient
Page et al.178
2016
Australia
Deprescribing in older people
Narrative literature review
Literature on deprescribing
To describe the genesis of deprescribing as an increasingly accepted medical and pharmaceutical intervention. It also provides an overview of deprescribing
Palagyi et al.179
2016
Australia
Barricades and brickwalls – a qualitative study exploring perceptions of medication use and deprescribing in long-term care
Qualitative focus group and interview study
GPs, staff members, residents and their relatives within LTCFs
To report the perceptions of medication use and the concept of deprescribing for LTCF residents, as identified by the RELEASE study participants. The application of these findings in informing the development of deprescribing initiatives within the aged care sector is discussed. RELEASE aims to improve understanding of the attitudes towards medication reduction held by the frail elderly in residential care
Petersen et al.79
2018
USA
Shed-MEDS: pilot of a patient-centred deprescribing framework reduces medications in hospitalised older adults being transferred to inpatient post-acute care
Cross-sectional study
40 Medicare-eligible, hospitalised patients with at least five prescribed medications
To describe a hospital-based, patient-centred deprescribing protocol (Shed-MEDS) and report pilot results
Pitkälä et al.181
2016
Finland
Herbal medications and other dietary supplements. A clinical review for physicians caring for older people
Literature review
Literature regarding older people’s use of dietary supplements with special reference to polypharmacy
To conduct a literature review on clinical considerations associated with dietary supplement use, focusing on benefits and harms, motivations for use and contribution to polypharmacy among older people
Le Couteur et al.182
2016
Australia
Polypharmacy in older people: when should you deprescribe?
Opinion piece/commentary
n/a
To describe the challenges of managing multimorbidity and polypharmacy and present an individualised, person-centred approach that takes into account multimorbidity
Pruskowski and Handler183
2017
USA
The DE-PHARM Project: a pharmacist-driven deprescribing initiative in a nursing facility
Quality improvement project
Residents in a nursing facility
To reduce the number of PIMs via accepted recommendations from the clinical pharmacist to the primary team
Reeve et al.184
2014
Australia
Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process
Literature review
n/a
To describe the development of a patient-centred deprescribing process
Reeve et al.185
2015
Australia
Barriers to optimising prescribing and deprescribing in older adults with dementia: a narrative review
Narrative review of the literature
Literature on optimising medications in older adults with dementia
To explore barriers to optimising prescribing and deprescribing of medication as the goal of care shifts from prolonging life to optimising quality of life
Reeve et al.6
2018
UK
Identifying enablers and barriers to individually tailored prescribing: a survey of healthcare professionals in the UK
Survey
419 health professionals across the UK
To examine health professionals’ perceptions of enablers and barriers to delivering individually tailored prescribing
Rieckert et al.186
2018
Germany
Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS study): a qualitative study of practical implementation in primary care
Qualitative interview study
General practitioners belonging to the intervention group of the PRIMA-eDS study
To examine how GPs experienced the use of the PRIMA-eDS tool, how GPs adopted the recommendations provided by the CMR and explores GPs’ ideas on the future implementation of the tool
Rigby187
2013
Australia
Interview crucial to HMR success
Opinion piece/commentary
n/a
To discuss the importance of interviews in home medications review
Rodriguez Perez180
2015
Spain
Deprescribing in patients with multimorbidity: a necessary process
Opinion piece/commentary
n/a
To discuss the importance of deprescribing in patients with multimorbidity
Rose et al.188
2019
Germany
Patient selection and general practitioners’ perception of collaboration in medication review
Qualitative interview study
GPs
To gain information on patient selection for a medication review by GPs. GP selection was compared with objective selection criteria on identifying patients who would benefit from a medication review the most. A secondary objective of this study was to get insight into GPs’ perceptions on interprofessional collaboration with pharmacists
Ross and Gillett189
2020
Canada
Confronting medicine’s dichotomies: older adults’ use of interpretative repertoires in negotiating the paradoxes of polypharmacy and deprescribing
Qualitative interview study
Older adults aged > 70 years taking part in the TAPER trial
To identify the medication paradoxes experienced by older adults taking multiple medications and describe the work that older adults do to bring them to resolution
Ross and Gillet190
2020
Canada
‘At 80 I know myself’: embodied learning and older adults’ experiences of polypharmacy and perceptions of deprescribing
Qualitative interview study
Older adults aged > 70 years taking part in the TAPER trial
To examine the forms of expertise that inform older adults’ decisions about how to use medications given concerns over polypharmacy and a clinical focus on deprescribing
Ross and Gillett191
2020
Canada
Forms of trust and polypharmacy among older adults
Qualitative interview study
Older adults aged > 70 years taking part in the TAPER trial
To examine how older adults make decisions about their medications through interconnected axes of trust that operate across social networks
Ryan and Hill192
2016
Australia
Making rational choices about how best to support consumers’ use of medicines: a perspective review
Literature review
n/a
To present perspectives on how to support consumers’ use of medicines
Schäfer et al.193
2017
Germany
Narrative medicine-based intervention in primary care to reduce polypharmacy: results from the cluster-randomised controlled trial MultiCare AGENDA
Two-arm cluster RCT
604 patients aged 65–84 years with at least three chronic conditions in general practice
To determine if patient-centred communication leads to a reduction in the number of medications taken without reducing health-related quality of life
Schöpf et al.194
2018
Germany
Elderly patients’ and GPs’ perspectives of patient–GP communication concerning polypharmacy: a qualitative interview study
Qualitative interview study
Patients aged ≥ 65 years with polypharmacy (five or more medications) and their GPs in a German primary health-care centre
To explore elderly patients’ and GPs’ perceptions of communication about polypharmacy, medication safety and approaches for empowerment
Schuling et al.195
2012
The Netherlands
Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study
Qualitative focus group study
GPs with a minimum of five years’ experience and active as GP trainers
To explore how experienced GPs feel about deprescribing medication in older patients with multimorbidity and to what extent they involve patients in these decisions
Scott et al.196
2013
Australia
Deciding when to stop: towards evidence-based deprescribing of drugs in older populations
Opinion piece/commentary
n/a
To describe the evidence base for a structured approach to deprescribing and explore the barriers that exist in routine practice
Sheppard et al.197
2018
UK
OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE): protocol for a randomised controlled non-inferiority trial
Protocol for a randomised controlled non-inferiority trial
Participants aged ≥ 80 years, with systolic blood pressure < 150 mmHg and receiving two or more antihypertensive medications
To examine whether or not antihypertensive medication reduction is possible in older patients without significant changes in blood pressure control at follow-up
Sinnige et al.198
2016
The Netherlands
Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care
Qualitative focus group study
Dutch GPs
To gain insight into GPs’ medication management strategies for patients with polypharmacy, and to explore the GPs’ perspectives and needs on decision-making support to facilitate this medication management
Sinnott et al.199
2015
Ireland
What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care
Qualitative interview study
Irish GPs
To explore how GPs make decisions when prescribing for multimorbid patients, with a view to informing intervention design
Sinnott et al.200
2015
Ireland
Improving medication management in multimorbidity: development of the MultimorbiditY COllaborative Medication Review And Decision-making (MY COMRADE) intervention using the Behaviour Change Wheel
Development of a medication review decision-making tool; systematic review and qualitative study with GPs
GPs
To develop an intervention to improve medication management in multimorbidity by GPs, within the overarching UK Medical Research Council guidance on complex interventions99
Sinnott et al.201
2017
Ireland
Improving medication management for patients with multimorbidity in primary care: a qualitative feasibility study of the MY COMRADE implementation intervention
Non-randomised feasibility study using a qualitative framework approach
GPs attending CPD in south-west Ireland
To assess the feasibility and acceptability of MY COMRADE by GPs
St Peter202
2015
USA
Management of polypharmacy in dialysis patients
Opinion piece/commentary
n/a
To discuss the management of polypharmacy in dialysis patients
Steinman and Hanlon203
2010
USA
Managing medications in clinically complex elders: ‘there’s got to be a happy medium’
Case study
84-year-old man with dementia with a history of atrial fibrillation, diabetes mellitus, hypertension, hyperlipidaemia, chronic kidney disease (estimated creatinine clearance of 42 ml/minute), and gastritis and gastro-oesophageal reflux disease
To describe a typical case of an older patient taking multiple medications and summarise the evidence-based literature about improving medication use and withdrawing specific drugs and drug classes. To present a systematic approach for how health professionals can assess and improve medication regimens
Straßner et al.204
2018
Germany
German healthcare professionals’ perspective on implementing recommendations about polypharmacy in general practice: a qualitative study
Qualitative interview and focus group study
24 GPs, four other medical specialists, one pharmacist, three nurses and six medical assistants as well as two mixed focus groups with 17 professionals
To identify determinants (hindering and facilitating factors) for the implementation of the recommendations in general practice
Sun et al.205
2019
Canada
Exploration of home care nurse’s experiences in deprescribing of medications: a qualitative descriptive study
Qualitative focus group study
11 home care nurses
To explore the barriers to and enablers of deprescribing from the perspective of home care nurses, as well as to conduct a scalability assessment of an educational plan to address the learning needs of home care nurses about deprescribing
Thomas and Killbey206
2011
UK
Complex medicines management
Pilot project of multidisciplinary reviews for patients with complex needs
Four patients with complex needs
To improve the quality of care for patients receiving multiple prescribed medicines for one or more long-term condition, using a holistic, evidence-based approach
Townsend et al.207
2003
UK
Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use
Qualitative interview study
23 men and women aged about 50 years with four or more chronic illnesses
To examine attitudes towards drug use among middle aged respondents with high levels of chronic morbidity
Turner et al.208
2016
Australia
What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals
Qualitative research using nominal group technique
11 residents/representatives, 19 GPs, 12 nurses and 14 pharmacists participated across six separate groups
To use NGT to generate then rank factors that GPs, nurses, pharmacists and residents or their representatives perceive are most important when deciding whether or not to deprescribe medications
Turner et al.209
2017
Australia
Is my older cancer patient on too many medications?
Commentary/opinion piece
n/a
To present a six-step process for deprescribing in older patients with cancer
Twigg et al.210
2017
UK
The UK Pharmacy Care Plan service: description, recruitment and initial views on a new community pharmacy intervention
Mixed methods using questionnaires and interviews
Pharmacists and patients
To describe the initial findings from the set up and delivery of a novel community pharmacy-based person-centred service
Uhl et al.211
2018
Germany
Patient-perceived barriers and facilitators to the implementation of a medication review in primary care: a qualitative thematic analysis
Qualitative interview study
31 patients (age ≥ 60 years, three or more chronic diseases, taking five or more drugs)
To gain insight into patient-perceived barriers to and facilitators of the implementation of medication review
van Middelaar et al.212
2018
The Netherlands
Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
Qualitative interview study
15 GPs
To explore GPs’ routines and considerations on (de)prescribing AHM in older patients, their judgement on usability of the current guideline and needs for future support
van Summeren et al.84
2017
The Netherlands
Outcome prioritisation tool for medication review in older patients with multimorbidity: a pilot study in general practice
Mixed-methods descriptive study
Older patients with multimorbidity (aged ≥ 69 years) with polypharmacy (five or more chronic medications) from the practices of 14 GPs
To determine proposed and observed medication changes when using an OPT during a medication review in general practice
Vandermause et al.213
2016
USA
Preserving self: medication-taking practices and preferences of older adults with multiple chronic medical conditions
Qualitative study using interviews and assessment of diaries
27 participants with multiple chronic conditions
To examine the experiences of older adults with multiple chronic medical conditions when a new medication was added to their existing multiple medication regimen
Voigt et al.214
2016
Germany
Why do family doctors prescribe potentially inappropriate medication to elderly patients?
Mixed methods using 10 semistandardised content analyses of patients’ records, qualitative interviews with FPs using open questions and selected patient-specific case vignettes, and qualitative interviews with FPs’ medical assistants
Patients and FPs
To give an overview of rates of PIM prescription in the study sample of elderly multimorbid patients with polymedication in the outpatient primary care setting; to explain influencing factors on prescription of PIM; to examine knowledge and application of PRISCUS; and to understand FPs’ reasons for prescription of PIM
Waller et al.215
2005
UK
Rational prescribing: the principles of drug selection and assessment of efficacy
Opinion piece/commentary
n/a
To provide an overview of rational prescribing
Weir et al.218
2018
Australia
Decision-making preferences and deprescribing: perspectives of older adults and companions about their medicines
Qualitative interview study
30 older people (aged > 75 years taking multiple medicines) and 15 companions
To explore decision-making about polypharmacy with older adults and their companions
Wilchesky et al.216
2018
Canada
The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study
Quasi-experimental feasibility pilot study
44 participating residents aged ≥ 65 years with severe dementia in three nursing homes in Quebec City, Canada
To test the feasibility of an interdisciplinary knowledge exchange intervention using a medication review guidance tool categorising medications as either ‘generally’, ‘sometimes’ or ‘exceptionally’ appropriate for nursing home residents with severe dementia
Williams et al.217
2004
USA
The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people
A RCT
Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks. A medication-change intervention group of 57 elders was compared with a control group of 76 elder adults
To determine whether or not a medication review by a specialised team would promote regimen changes in elders taking multiple medications, and to measure the effect of regimen changes on monthly cost and functioning
Zechman et al.85
2019
Switzerland
Barriers and enablers for deprescribing among older, multimorbid patients with polypharmacy: an explorative study from Switzerland
Mixed-methods interview study
Patients of a cluster-randomised study in northern Switzerland
To explore attitudes, beliefs, and concerns towards deprescribing among older, multimorbid patients with polypharmacy who chose not to pursue at least one of their GP’s offers to deprescribe