Special Issue "Deprescribing"

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (30 June 2018).

Special Issue Editor

Dr. Cheryl A. Sadowski
Website
Guest Editor
Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 3-229 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
Interests: geriatrics; geriatric syndromes; falls; attitudes toward older adults; deprescribing; medication appropriateness
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

I would like to invite you to contribute to a Special issue on “Deprescribing” to be published in the online journal Pharmacy (https://www.mdpi.com/journal/pharmacy). Pharmacy is indexed by the “Emerging Sources Citation Index (ESCI)”, the core collection of Web of Science.

This Special issue will include contributions from researchers from all over the world dealing with a variety of issues such as:

  • Definitions and frameworks for deprescribing
  • The imperative for deprescribing in an age of medicalization and polypharmacy
  • Barriers and challenges to deprescribing
  • Policies and incentives supporting deprescribing
  • Successful implementation and practices supporting deprescribing

Contributions can be in the form of reviews or research articles and should be 10–20 pages (A4) long, with 10-20 bibliographic references and several figures (graphs, flow-charts, etc.). They will be pre-checked by the guest editor and peer reviewed in the usual fashion. The whole collection will be published in book form.

Prof. Dr. Cheryl A. Sadowski
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Deprescribing
  • Medication reduction
  • Pharmacy
  • Medication burden
  • Polypharmacy

Published Papers (7 papers)

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Editorial

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Open AccessEditorial
Deprescribing—A Few Steps Further
Pharmacy 2018, 6(4), 112; https://doi.org/10.3390/pharmacy6040112 - 11 Oct 2018
Cited by 2
(This article belongs to the Special Issue Deprescribing)

Research

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Open AccessArticle
Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing
Pharmacy 2018, 6(3), 76; https://doi.org/10.3390/pharmacy6030076 - 25 Jul 2018
Cited by 5
Abstract
Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence [...] Read more.
Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period. Eighty-three patients were included. The median age was 63 (Interquartile range; IQR = 22), 50% were males, and the mean number of co-morbidities was 3.14 ± 1.64. The prevalence of polypharmacy was 97.6% with a 95% CI (91.6%–99.7%). Medication use without indication, was the highest identified MRPs at 36% (102/280), followed by subtherapeutic dosing at 23% (65/280), and overdosing at 15% (41/280). The number of comorbidities, the presence of ischemic heart disease, and respiratory diseases were the main predictors of the increased number of medications. Polypharmacy is highly prevalent among the Saudi hemodialysis population. A review of the medications prescribed by the pharmacist facilitated the identification of MRPs and provided opportunities for deprescribing to optimize medication use and to reduce polypharmacy in hemodialysis patients. Full article
(This article belongs to the Special Issue Deprescribing)
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Open AccessArticle
Benzodiazepines Withdrawal: Initial Outcomes and Long-Term Impact on Falls in a French Nursing Home
Pharmacy 2018, 6(2), 30; https://doi.org/10.3390/pharmacy6020030 - 06 Apr 2018
Cited by 3
Abstract
Long-term use of benzodiazepines (BZDs) is known to induce tolerance and dependence, and increase the risk of falls-related injuries in older adults. We present a study carried out in a French nursing home that concerns the implementation of a BZD withdrawal program reassessed [...] Read more.
Long-term use of benzodiazepines (BZDs) is known to induce tolerance and dependence, and increase the risk of falls-related injuries in older adults. We present a study carried out in a French nursing home that concerns the implementation of a BZD withdrawal program reassessed at one year. BZD deprescription was achieved by gradual cessation of doses. A secondary benefit of this program was assessed by comparing the number of falls among residents before and after withdrawal. The number of falls was recorded over a six-month period prior to the onset of withdrawal (T1) and then over a six-month period after reassessment at one year (T2). At the beginning, 31 (28.7%) of the patients were under BZD. Total deprescription was obtained for 11 patients. The number of falls per patient over the T1 period was not different between the two groups (future non-withdrawn and withdrawn patients in BZD): 2.1 ± 1.3 and 2.3 ± 0.6 falls per resident, respectively. Conversely, the number of falls per patient was significantly decreased in the population completely withdrawn in BZD between the T1 and T2 periods (2.3 ± 0.6 vs. 0.5 ± 0.2 falls, p = 0.01). The results show that BZD deprescription, through a gradual reduction of doses, is possible to achieve. Full article
(This article belongs to the Special Issue Deprescribing)
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Open AccessArticle
De-Prescribing of Psychotropic Medications in the Adult Population with Intellectual Disabilities: A Commentary
Pharmacy 2018, 6(2), 28; https://doi.org/10.3390/pharmacy6020028 - 30 Mar 2018
Cited by 1
Abstract
The population with intellectual disabilities is one of the most vulnerable groups in society. Medication use is the main therapeutic intervention in this population and psychotropic medications can be prescribed for mental health conditions and for challenging behaviors. Clinical experience of prescribers and [...] Read more.
The population with intellectual disabilities is one of the most vulnerable groups in society. Medication use is the main therapeutic intervention in this population and psychotropic medications can be prescribed for mental health conditions and for challenging behaviors. Clinical experience of prescribers and pharmacists working with people with intellectual disabilities suggests that reducing or stopping psychotropic medication is not always straightforward. What is required is rational, rather than rationed, prescribing of psychotropic medications. Concerns of clinicians working with people with intellectual disabilities and both formal and informal carers can result in maintenance of the ‘status quo.’ Setting-related, carer-related and staff-related factors play an important role in the real world of people with intellectual disabilities. Optimizing medication regimens in the adult population with intellectual disabilities is complicated but it is recognized that efforts to improve the current state of medication utilization are required for many individuals with intellectual disabilities. Pharmacists have a responsibility to include the person and/or their carer in their efforts to promote optimization of psychotropic medication use in environment in which the person lives. Full article
(This article belongs to the Special Issue Deprescribing)

Review

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Open AccessReview
Deprescription in Advanced Cancer Patients
Pharmacy 2018, 6(3), 88; https://doi.org/10.3390/pharmacy6030088 - 21 Aug 2018
Cited by 4
Abstract
The use of multiple drugs is often referred to as polypharmacy, although this term has not been precisely defined. Frequently, drugs are used unwisely in multiple combinations increasing the risk of adverse reactions, or for the long-term prevention of diseases in patients with [...] Read more.
The use of multiple drugs is often referred to as polypharmacy, although this term has not been precisely defined. Frequently, drugs are used unwisely in multiple combinations increasing the risk of adverse reactions, or for the long-term prevention of diseases in patients with a short life expectancy who, therefore, will not benefit from them. The reflection on this has led to the introduction of the concept of deprescription. There are many reasons for the inappropriate drug prescription and barriers to reduce medications. Tools were developed to help prescribers to limit the number of prescribed drugs that patients are taking. Several studies have shown that deprescription of some drugs is possible and safe and can even have a positive influence on wellbeing, cognitive function, falls, and admission to a hospital. Deprescription should be individualized and carried out, as far as possible, in agreement with patients and their families. A six-step method for deprescription is proposed. Full article
(This article belongs to the Special Issue Deprescribing)

Other

Open AccessProject Report
Improving Pharmacists’ Targeting of Patients for Medication Review and Deprescription
Pharmacy 2018, 6(2), 32; https://doi.org/10.3390/pharmacy6020032 - 16 Apr 2018
Cited by 4
Abstract
Background: In an acute hospital setting, a multi-disciplinary approach to medication review can improve prescribing and medicine selection in patients with frailty. There is a need for a clear understanding of the roles and responsibilities of pharmacists to ensure that interventions have the [...] Read more.
Background: In an acute hospital setting, a multi-disciplinary approach to medication review can improve prescribing and medicine selection in patients with frailty. There is a need for a clear understanding of the roles and responsibilities of pharmacists to ensure that interventions have the greatest impact on patient care. Aim: To use a consensus building process to produce guidance for pharmacists to support the identification of patients at risk from their medicines, and to articulate expected actions and escalation processes. Methods: A literature search was conducted and evidence used to establish a set of ten scenarios often encountered in hospitalised patients, with six or more possible actions. Four consultant physicians and four senior pharmacists ranked their levels of agreement with the listed actions. The process was redrafted and repeated until consensus was reached and interventions were defined. Outcome: Generalised guidance for reviewing older adults’ medicines was developed, alongside escalation processes that should be followed in a specific set of clinical situations. The panel agreed that both pharmacists and physicians have an active role to play in medication review, and face-to-face communication is always preferable to facilitate informed decision making. Only prescribers should deprescribe, however pharmacists who are not also trained as prescribers may temporarily “hold” medications in the best interests of the patient with appropriate documentation and a follow up discussion with the prescribing team. The consensus was that a combination of age, problematic polypharmacy, and the presence of medication-related problems, were the most important factors in the identification of patients who would benefit most from a comprehensive medication review. Conclusions: Guidance on the identification of patients on inappropriate medicines, and subsequent pharmacist-led intervention to prompt and promote deprescribing, has been developed for implementation in an acute hospital. Full article
(This article belongs to the Special Issue Deprescribing)
Open AccessBrief Report
Does a Consumer-Targeted Deprescribing Intervention Compromise Patient-Healthcare Provider Trust?
Pharmacy 2018, 6(2), 31; https://doi.org/10.3390/pharmacy6020031 - 16 Apr 2018
Cited by 5
Abstract
One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust [...] Read more.
One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between older adults and their healthcare providers. An educational brochure was distributed to community-dwelling older adults by community pharmacists in order to trigger deprescribing conversations. At baseline and 6-months post-intervention, participants completed the Primary Care Assessment Survey, which measures patient trust in doctors and pharmacists. Changes in trust were ascertained post-intervention. Proportions with 95% confidence intervals (CI), and logistic regression were used to determine a shift in trust and associated predictors. 352 participants responded to the questionnaire at both time points. The majority of participants had no change or gained trust in their doctors for items related to the choice of medical care (78.5%, 95% CI = 74.2–82.8), communication transparency (75.4%, 95% CI = 70.7–79.8), and overall trust (81.9%, 95% CI = 77.9–86.0). Similar results were obtained for participants’ perceptions of their pharmacists, with trust remaining intact for items related to the choice of medical care (79.4%, 95% CI = 75.3–83.9), transparency in communicating (82.0%, 95% CI = 78.0–86.1), and overall trust (81.6%, 95% CI = 77.5–85.7). Neither age, sex nor the medication class targeted for deprescribing was associated with a loss of trust. Overall, the results indicate that patient-focused deprescribing interventions do not shift patients’ trust in their healthcare providers in a negative direction. Full article
(This article belongs to the Special Issue Deprescribing)
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