What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: A modified dephi process

PLoS ONE

Volumn 10, Issue 4, 2015, Pages

  Farrell, Barbara ^a,b,c   Tsang, Corey ^a,c   Raman Wilms, Lalitha ^d   Irving, Hannah ^a   Conklin, James ^a,e   Pottie, Kevin ^a,b  

^a BRUYÈRE RESEARCH INSTITUTE   (Canada)

^b UNIVERSITY OF OTTAWA   (Canada)

^c UNIVERSITY OF WATERLOO   (Canada)

^d UNIVERSITY OF TORONTO   (Canada)

^e Gina Cody School of Engineering and Computer Science   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

ATYPICAL ANTIPSYCHOTIC AGENT; BENZODIAZEPINE DERIVATIVE; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; PROTON PUMP INHIBITOR; TRICYCLIC ANTIDEPRESSANT AGENT;

ADULT; AGED; ARTICLE; CANADIAN; CARDIOVASCULAR DISEASE; CHRONIC DISEASE; CONSENSUS; DELPHI STUDY; ELDERLY CARE; EVIDENCE BASED PRACTICE; FEMALE; GASTROINTESTINAL DISEASE; GENERAL PRACTITIONER; GERIATRICIAN; HUMAN; INAPPROPRIATE PRESCRIBING; MALE; MENTAL DISEASE; NEUROLOGIC DISEASE; NURSE PRACTITIONER; PHARMACIST; POLYPHARMACY; CANADA; DEPRESCRIPTION; DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; GERIATRICS; HEALTH SERVICE; MIDDLE AGED; PRESCRIPTION; QUESTIONNAIRE;

ADULT; AGED; CANADA; DELPHI TECHNIQUE; DEPRESCRIPTIONS; DRUG PRESCRIPTIONS; DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; EVIDENCE-BASED PRACTICE; FEMALE; GERIATRICS; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; MALE; MIDDLE AGED; POLYPHARMACY; SURVEYS AND QUESTIONNAIRES;

EID: 84928920031     PISSN: None     EISSN: 19326203     Source Type: Journal    
DOI: 10.1371/journal.pone.0122246     Document Type: Article

References (64)

1. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012; 344: e3502. doi: 10.1136/bmj.e3502 PMID: 22645185
2. Heath I. Overdiagnosis: when good intentions meet vested interests-an essay by Iona Heath. BMJ. 2013; 347: f6361. doi: 10.1136/bmj.f6361 PMID: 24162944
3. Welch GH, Schwartz LM, Woloshin S. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston: Beacon Press; 2011
4. Godlee F. Preventing overdiagnosis. BMJ. 2012; 344: e3783. doi: 10.1136/bmj.e3783
5. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007; 5: 345-51. doi: 10.1016/j.amjopharm.2007.12.002 PMID: 18179993
6. Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006; 61: 218-23. PMID: 16433876
7. Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging. 2012; 29: 359-376. doi: 10.2165/ 11599460-000000000-00000 PMID: 22550966
8. Jyrkka J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging. 2009; 26: 1039-48. doi: 10.2165/11319530-000000000-00000 PMID: 19929031
9. Reason B, Terner M, McKeag MA, Tipper B, Webster G. The impact of polypharmacy on the health of Canadian seniors. Fam Pract. 2012; 29: 427-32. doi: 10.1093/fampra/cmr124 PMID: 22223743
10. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011; 365: 2002-12. doi: 10.1056/NEJMsa1103053 PMID: 22111719
11. Wu C, Bell CM, Wodchis WP. Incidence and economic burden of adverse drug reactions among elderly patients in Ontario emergency departments, a retrospective study. Drug Saf. 2012; 35: 769-781. doi: 10.2165/11599540-000000000-00000 PMID: 22823502
12. Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG.Medication withdrawal trials in people aged 65years and older: a systematic review. Drugs Aging. 2008; 25: 1021-31. doi: 10.2165/0002512-200825120-00004 PMID: 19021301
13. Gnjidic D, Le Couteur DG, Kouladjian L, Hilmer SR. Deprescribing trials: methods to reduce polypharmacy and the impact on prescribing and clinical outcomes. Clin Geriatr Med. 2012; 28: 237-253. doi: 10.1016/j.cger.2012.01.006 PMID: 22500541
14. Garfinkel D, Zur-Gil S, Ben-Israel J.The war against polypharmacy: a new cost-effective geriatricpalliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007; 9: 430-34. PMID: 17642388
15. Anthierens S, Tansens A, Petrovic M, Christiaens T. Qualitative insights into general practitioners views on polypharmacy. BMC Fam Pract. 2010; 11: 65[6 p.]. doi: 10.1186/1471-2296-11-65 PMID: 20840795
16. Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013; 30: 793-807. doi: 10.1007/s40266-013-0106-8PMID: 23912674
17. Zulman DM, Sussman JB, Chen X, Cigolle CT, Blaum CS, Hayward RA. Examining the evidence: A systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011; 26: 783-790. doi: 10.1007/s11606-010-1629-x PMID: 21286840
18. Wehling M. Guideline-driven polypharmacy in elderly, multimorbid patients is basically flawed: there are almost no guidelines for these patients. J Am Geriatr Soc. 2011; 59: 376-77. doi: 10.1111/j.1532-5415.2011.03252.x PMID: 21314663
19. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012; 60: 616-31. doi: 10.1111/j.1532-5415.2012.03923.x PMID: 22376048
20. O 'Mahony D, Gallagher P, Ryan C, Byrne S, Hamilton H, Barry P, et al. STOPP and START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med. 2010; 1: 45-51. doi: 10.1016/j.eurger.2010.01.007
21. Schunemman HJ, Wiercioch W, Etxeandia I, Falavigna M, Santesso N, Mustafa R, et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2014; 186: E123-E142. doi: 10.1503/cmaj.131237 PMID: 24344144
22. Brouwers M, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, Fervers B, Graham ID, Grimshaw J, Hanna S, Littlejohns P, Makarski J, Zitzelsberger L for the AGREE Next Steps Consortium. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J. 2010. Dec 2010; 182:E839-842. doi: 10.1503/090449
23. Keeney S, Hasson F, Mckenna H. The Delphi Technique in Nursing and Health Research. West Sussex: John Wiley & Sons Ltd; 2010.
24. Hamilton H, Gallagher PF, O'Mahony D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr. 2009; 9: 5. [4 p.] doi: 10.1186/1471-2318-9-5 PMID: 19175914
25. Lane CJ, Bronskill SE, Sykora K, Dhalla IA, Anderson GM, Mamdani MM, et al. Potentially inappropriate prescribing in Ontario community-dwelling older adults and nursing home residents. J Am Geriatr Soc. 2004; 52: 861-6. PMID: 15161447
26. Canadian Institute for Health Information. Drug Claims by Seniors: An Analysis Focusing on Potentially Inappropriate Medication Use, 2000 to 2006. Canadian Institute for Health Information. 2007. Available: https://secure.cihi.ca/free-products/Potentially-Inappropriate-Medications-EN.pdf.
27. Bierman AS, Pugh MJ, Dhalla I, Amuan M, Fincke BG, Rosen A, et al. Sex differences in inappropriate prescribing among elderly veterans. Am J Geriatr Pharmacother. 2007; 5: 147-61. PMID: 17719517
28. Ontario Drug Benefit Program. 2010/11 Report Card for the Ontario Drug Benefit Program. Ministry of Health and Long-Term Care. 2012. Available: http://www.health.gov.on.ca/en/public/programs/drugs/ publications/opdp/docs/odb-report-10.pdf.
29. Wu C, Bell CM, Wodchis WP. Incidence and economic burden of adverse drug reactions among elderly patients in Ontario emergency departments: a retrospective study. Drug Saf. 2012; 35: 769-81. doi: 10. 2165/11599540-000000000-00000 PMID: 22823502
30. Canadian Institute for Health Information. Adverse Drug Reaction-Related Hospitalizations Among Seniors,2006 to 2011. Canadian Institute for Health Information. 2013. Available at:https://secure.cihi.ca/ free-products/Hospitalizations%20for%20ADR-ENweb.pdf.
31. Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008; 56: 1946-52. doi: 10.1111/j.1532-5415.2008.01916.x PMID: 18771457
32. Sergi G, De Rui MD, Sarti S, Manzato E. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging. 2011; 28: 509-18. doi: 10.2165/ 11592010-000000000-00000 PMID: 21721596
33. Steinman MA, Hanlon JT. Managing medications in clinically complex elders: "There's got to be a happy medium". JAMA. 2010; 304: 1592-601. doi: 10.1001/jama.2010.1482 PMID: 20940385
34. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010; 170: 1648-54. doi: 10.1001/ archinternmed.2010.355 PMID: 20937924
35. bpacnz. A practical guide to stopping medicines in older people. Best Practice Journal 2010; 27: [4 p.].
36. Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006; 166: 605-9. PMID: 16567597
37. Hardy JE and Hilmer SN. Deprescribing in the Last Year of Life. Journal of Pharmacy Practice and Research. 2011; 41: 146-51.
38. Le Couteur D, Banks E, Gnjidic D, McLachlan A. Deprescribing. Aust Prescr 2011; 34: 182-5.
39. Woodward MC. Deprescribing: Achieving Better Health Outcomes for Older People Through Reducing Medications. Journal of Pharmacy Practice and Research. 2003; 33: 323-8.
40. Gokula M and Holmes HM. Tools to reduce polypharmacy. Clin Geriatr Med. 2012; 28: 323-41. doi: 10. 1016/j.cger.2012.01.011 PMID: 22500546
41. Voshaar RC, Couvee JE, van Balkom AJ, Mulder PG, Zitman FG. Strategies for discontinuing longterm benzodiazepine use: meta-analysis. Br J Psychiatry. 2006; 189: 213-20. PMID: 16946355
42. Hsu CC and Sandford BA. The Delphi Technique: Making Sense of Consensus. Practical Assessment, Research and Evaluation. 2007; 12: 10 [8 p.].
43. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64: 383-94. doi: 10. 1016/j.jclinepi.2010.04.026 PMID: 21195583
44. Hasson F, Keeney S and McKenna H.Research guidelines for the Delphi Survey. J Adv Nurs. 2000; 32: 1008-15. PMID: 11095242
45. Schmidt RC. Managing Delphi Surveys using nonparametric Statistical Techniques. Decision Sciences. 1997; 28: 763-74.
46. Field A. Non-parametric tests. In: Wright DB, editor. Discovering statistics using SPSS;2009 pp. 539-583.
47. Pare G, Cameron AF, Poba-Nazaou P, Templier M. A systematic assessment of rigor in information systems ranking-type Delphi studies. Information & management. 2013; 50: 201-217.
48. Patton MQ. Qualitative Analysis and Interpretation. In: Laughton CD, editor. Qualitative Research and Evaluation Methods;2002 pp. 431-540.
49. Hsieh H and Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15: 1277-1288. PMID: 16204405
50. Holey EA, Feeley JL, Dixon J, Whittaker VJ. An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol. 2007; 7: 52-62. PMID: 18045508
51. American Geriatrics Society. AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Society.2012. Available: http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria-JAGS.pdf
52. Swinkels H, Pottie K, Tugwell P, Rashid M, Narasiah L; Canadian Collaboration for Immigrant and Refugee Health. Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions. CMAJ. 2011; 183: e928-32. doi: 10.1503/cmaj.09029 PMID: 20547714
53. Canadian Institute for Health Information. The Use of Selected Psychotropic Drugs Among Seniors on Public Drug Programs in Canada, 2001 to 2010. Canadian Institute for Health Information. 2012. Available: https://secure.cihi.ca/free-products/psychotropic-AIB-2012-en.pdf.
54. Sithamparanathan K, Sadera A, Leung L. Adverse effects of benzodiazepine use in elderly people: a meta-analysis. Asian J Gerontol Geriatr. 2012; 7: 107-11.
55. Gould RL, Coulson MC, Patel N, Highton-Williamson E, Howard RJ. Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials. Br J Psychiatry. 2014; 204: 98-107. doi: 10.1192/bjp.bp.113.126003 PMID: 24493654
56. Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AI, van Driel ML, et al. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2013; 3:CD007726. doi: 10.1002/14651858.CD007726.pub2 PMID: 23543555
57. Chokshi NP, Messerli FH, Sutin D, Supariwala AA, Shah NR. Appropriateness of Statins in Patients Aged ≥-80 Years and Comparison to Other Age Groups. Am J Cardiol. 2012; 110: 1477-81. doi: 10. 1016/j.amjcard.2012.06.058 PMID: 22901970
58. Byatt K. Overenthusiastic stroke risk factor modification in the over-80s: Are we being disingenuous to ourselves, and to our oldest patients? Evid Based Med 2014; 19: 121-2. doi: 10.1136/eb-2013-101646PMID: 24574366
59. Mottram PG, Wilson K, Stobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev. 2006;(1:) : CD003491 PMID: 16437456
60. Heidelbaugh JJ, Goldberg KL, Inadomi JM.Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care. 2010; 16: e228-34 PMID: 21250399
61. Heidelbaugh JJ, Goldberg KL, Inadomi JM. Overutilization of proton pump inhibitors: a review of costeffectiveness and risk [corrected]. Am J Gastroenterol. 2009; 104 Suppl 2: S27-32. doi: 10.1038/ajg. 2009.49 PMID: 19262544
62. Spijker-Huiges A, Winters JC, Meyboom-De Jong B. Patients' views on dyspepsia and acid suppressant drug therapy in general practice. Eur J Gen Pract. 2006; 12: 10-4. PMID: 16945866
63. Ott SM. What is the optimal duration of bisphosphonate therapy? Cleve Clin J Med. 2011; 78: 619-30.doi: 10.3949/ccjm.78a.11022 PMID: 21885695
64. Sykes L, Wood E, Kwan J. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database Syst Rev. 2014; 1:CD005398. doi: 10.1002/14651858.CD005398.pub3 PMID: 24464793