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Practical Incorporation of Stakeholder-Informed Ethics into Research Funding Decisions

Lee M, Brandt N, Reyes CE, Mansour D, Maslow K, Sarkisian C. Practical Incorporation of stakeholder-Informed Ethics into Research Funding Decisions. Progress in Community Health Partnerships: Research, Education, and Action (PCHP). 2024 Jan 2. Epub ahead of print. The paper explores the ethical imperative in the National Institute on Aging’s mission, emphasizing the inclusion of under-represented community members and stakeholders to rectify historical disparities. Despite the NIA’s budgetary focus on improving diversity in research, achieving racial/ethnic representation remains challenging. The paper explores how two NIA-funded initiatives, RCMAR/CHIME and USDeN, involve stakeholders in reviewing pilot grants, highlighting the crucial role of patient and stakeholder engagement for study relevance and addressing specific population needs. The goals include delineating stakeholder engagement processes, exploring challenges, and sharing lessons learned to contribute insights toward improving research diversity and applicability. RCMAR/CHIME and USDeN, both NIH/NIA-funded research centers, aim to reduce health disparities and develop evidence on deprescribing

Evaluation of a benzodiazepine deprescribing quality improvement initiative for older adults in primary care

Chae S, Lee E, Lindenberg J, Shen K, Anderson TS. Evaluation of a benzodiazepine deprescribing quality improvement initiative for older adults in primary care. J Am Geriatr Soc. 2023 Dec 26. doi: 10.1111/jgs.18728. Epub ahead of print. PMID: 38147454. This study, conducted at a large US academic medical center, aimed to evaluate the impact of a low-intensity benzodiazepine deprescribing initiative in primary care involving individuals aged 65 or older. The primary objective was to evaluate patient and clinician engagement challenges within this initiative, highlighting the importance of understanding these challenges for future interventions aimed at encouraging proactive deprescribing conversations. The low-intensity benzodiazepine deprescribing quality improvement program was implemented in a large academic primary care clinic in Massachusetts between February and April 2022. The target population comprised adults aged 65 and older with at least one prescription for benzodiazepines from primary care physicians (PCPs) in the previous year, excluding those with

Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

Weir KR, Shang J, Choi J, Rana R, Vordenberg SE. Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation. JAMA Netw Open. 2023 Oct 2;6(10):e2337281. doi: 10.1001/jamanetworkopen.2023.37281. PMID: 37819657; PMCID: PMC10568363. This investigation aimed to understand why older adults disagree with deprescribing recommendations from primary care physicians in hypothetical scenarios. The study cohort consisted of individuals aged 65 or older from the United Kingdom, the United States, Australia, and the Netherlands. The study utilized an online survey that described a hypothetical vignette about Mrs. EF, a 76-year-old woman, and her primary care physician’s deprescribing recommendation to stop either lansoprazole or simvastatin. Using a 6-point Likert scale, participants rated their agreement with the physician’s recommendation to stop the medication, and those strongly disagreeing or disagreeing were asked to provide free text comments explaining their disagreement. The study performed a content analysis of these free-text responses. The analyses involved 899

Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia

Norton JD, Zeng C, Bayliss EA, Shetterly SM, Williams N, Reeve E, Wynia MK, Green AR, Drace ML, Gleason KS, Sheehan OC, Boyd CM. Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia. JAMA Netw Open. 2023 Oct 2;6(10):e2336728. Deprescribing is challenging. While a number of qualitative studies have explored clinician barriers to deprescribing, relatively little work has been done to quantify clinician’s perceptions of the relative importance of these barriers. The Norton et al. study, conducted from January 15 to December 31, 2021, was a cross-sectional national survey aiming to investigate how primary care physicians prioritize ethical and pragmatic factors when making deprescribing decisions for older adults (aged 65+) with moderate dementia. The survey sought to identify the biggest and smallest barriers to deprescribing in situations where ethical dilemmas may arise by using best-worst scaling methods to rank nine influencing factors. In doing so, the study

Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation

Pitts SI, Olson S, Yanek LR, Wang N, Woodroof T, Chen AR. Pharmacy e-Prescription Dispensing Before and After CancelRx Implementation. JAMA Intern Med. 2023;183(10):1120–1126. doi:10.1001/jamainternmed.2023.4192 The primary objective of this study was to evaluate the impact of implementing e-prescription cancellation messaging (CancelRx) on medication dispensing after e-prescription discontinuation within the electronic health record (EHR).  Pitts et al. conducted a case series study with an interrupted time series analysis design at an urban academic medical center, spanning from one year before CancelRx implementation on January 15, 2018, to approximately a year after, concluding on December 7, 2019. The study also aimed to investigate variations in medication dispensing patterns based on factors such as pharmacy and medication class. The study included patients who received at least one e-prescription in ambulatory care within a two-year period surrounding CancelRx’s January 15, 2019 implementation. The analysis covered pre-post comparisons, variations by pharmacy and medication class using EHR

Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults – A Randomized Clinical Trial

Herrinton LJ, Lo K, Alavi M, Alexeeff SE, Butler KM, Chang C, Chang CC, Chu VL, Krishnaswami A, Deguzman LH, Prausnitz S, Mason MD, Draves M. Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2023 Jul 3;6(7):e2322505. doi: 10.1001/jamanetworkopen.2023.22505. PMID: 37428504; PMCID: PMC10334220. The study by Herrinton et al. was a randomized clinical trial conducted from October 2020 to July 2022 within the Kaiser Permanente Northern California healthcare system. Its primary goal was to assess the effectiveness and safety of a bundled hyperpolypharmacy deprescribing intervention among older adults (76 years and older) using ten or more prescription medications. The study’s primary objectives were to measure changes in the number of medications prescribed and the occurrence of geriatric syndrome components reflecting adverse drug effects. Secondary endpoints included healthcare utilization and adverse drug withdrawal effects. The study sought to determine if

International Deprescribing Journal Club

Lessons from a pilot of ALIGN: Aligning Medications with What Matters Most Description: ALIGN is a pragmatic, pharmacist-led telehealth intervention in primary care to optimize medications for people living with dementia and reduce inappropriate polypharmacy by focusing on what matters most to patients and care partners. Dr. Green presented on key learnings from the ALIGN pilot, implementation successes and challenges, and plans for a full-scale embedded pragmatic clinical trial. Presented by: Dr. Ariel Green Hosted by: US Deprescribing Research Network Date: September 20, 2023 Click here to download slides (PDF) Click here to learn about upcoming and past journal club events

Stakeholder Perspectives on Factors Related to Deprescribing Potentially Inappropriate Medications in Older adults Receiving Dialysis

Hall RK, Rutledge J, Lucas A, Liu CK, St Clair Russell J, St Peter W, Fish LJ, Colón-Emeric C. Stakeholder Perspectives on Factors Related to Deprescribing Potentially Inappropriate Medications in Older Adults Receiving Dialysis. Clin J Am Soc Nephrol. 2023 Jul 27. doi: 10.2215/CJN.0000000000000229. Epub ahead of print. PMID: 37499693. The study by Hall et al. was an observational qualitative study conducted in Durham, North Carolina, involving semi-structured interviews and focus groups with key stakeholders. It aimed to understand the perspectives of clinicians and patients regarding deprescribing potentially inappropriate medications in older adults receiving dialysis. The study’s primary objective was to identify factors affecting the integration of deprescribing in dialysis clinics, informing the development of a targeted program. It addressed obstacles including system-level issues, unclear co-management, knowledge gaps, and patient preferences to improve medication management in this healthcare context. The study encompassed 76 participants, with 53 clinicians and 23 patients,

Medication misuse and overuse in community-dwelling persons with dementia

Deardorff WJ, Jing B, Growdon ME, Yaffe K, Boscardin WJ, Boockvar KS, Steinman MA. Medication misuse and overuse in community-dwelling persons with dementia. J Am Geriatr Soc. 2023 Jun 5. doi: 10.1111/jgs.18463. Epub ahead of print. PMID: 37272899. The study by Deardorff et al. investigated medication misuse and overuse within the community-dwelling older adult population affected by dementia. Using Health and Retirement Study (HRS) data from 2008 to 2018, a nationally representative survey of U.S. adults, the main goal was to characterize potentially problematic medication use, covering diabetes and hypertension overtreatment, cognition-impairing drugs, and medications from consensus criteria (2019 Beers and STOPP Version 2). By comparing medication trends between those with and without dementia, it seeks to provide insights into problematic prescribing, highlighting areas for interventions and deprescribing to enhance care quality for individuals with dementia. The study cohort comprised individuals aged 66 years and above, identified as having dementia

Deprescribing to optimise health outcomes for frail older people: a double-blind placebo-controlled randomised controlled trial-outcomes of the Opti-med study

Etherton-Beer C, Page A, Naganathan V, Potter K, Comans T, Hilmer SN, McLachlan AJ, Lindley RI, Mangin D. Deprescribing to optimise health outcomes for frail older people: a double-blind placebo-controlled randomised controlled trial-outcomes of the Opti-med study. Age Ageing. 2023 May 1;52(5):afad081. doi: 10.1093/ageing/afad081. PMID: 37247404; PMCID: PMC10226731. The Opti-med study, conducted between 2014 and 2018, was a double-blind, randomized, placebo-controlled trial conducted across Sydney and Perth. The study’s primary objective was to investigate the effects of deprescribing multiple medications in the target population of older individuals residing in residential aged care facilities (RACFs). The study aimed to assess the impact of deprescribing on survival, quality of life, and clinical outcomes within this population while focusing on reducing medication burden and optimizing medication use. The authors conducted the study with three groups: blinded control, blinded intervention, and open intervention. The intervention in this study involved a structured process of medication

Deprescribing statins, considerations for informed decision making

Thomas C, Ellison H, Taffet GE. Deprescribing statins, considerations for informed decision making. J Am Geriatr Soc. 2023 Apr 21. doi: 10.1111/jgs.18362. Epub ahead of print. PMID: 37082816. To address ongoing uncertainties in deprescribing statins, Thomas et al. authored a commentary that explores key considerations and cautions when stopping these medications. Deprescribing aims to manage risks associated with polypharmacy in older adults. Due to their widespread use, uncertain benefits, and potential adverse effects, statins are a potential target for deprescribing. While statins are effective in reducing cardiovascular events in older patients with preexisting vascular disease, the evidence for primary prevention in older populations is mixed. The decision whether to start a statin is an important one that requires careful consideration.   Thomas et al. highlight the importance of distinguishing between stopping and starting these medications when considering the biologic mechanisms of statin discontinuation. Chronic inhibition of a pathway, as observed with

Frail older adults taking cardiometabolic medications: When less is more

Chaitoff A, Haff N, Lauffenburger JC, Choudhry NK. Medication de-escalation opportunities among frail older adults with strictly-controlled cardiometabolic disease [published online ahead of print, 2023 Apr 4]. J Am Geriatr Soc. 2023;10.1111/jgs.18368. doi:10.1111/jgs.18368 Many patients with hypertension, diabetes, and heart disease benefit from cardiometabolic disease medications. However, the number of medications available and potential downstream complications put patients at risk of polypharmacy. For frail older adults with strictly-controlled cardiometabolic disease, risk-benefit tradeoffs may favor de-escalating medications. A team of researchers at the Center for Healthcare Delivery Sciences at the Brigham and Women’s Hospital set out to clarify potential opportunities to de-escalate medications within this patient population. Using data from the National Health and Nutrition Examination Survey (NHANES) collected between 2005-2018, researchers evaluated adults age 65 and older with frailty. Researchers noted potential opportunity for de-escalating if the patient was taking medication for hypertension, diabetes, or heart disease and exceeded targets

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