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Use of medications of questionable benefit is common in end of life care. In order to effectively carry out deprescribing, it is important to gain insight into the perspectives of patients and their relatives. Thus, our objective was to explore perspectives on deprescribing among older adults with limited life expectancy and their relatives. We conducted semi‐structured interviews with ten nursing home residents and nine relatives. Interviews were analysed using systematic text condensation. Four main themes were identified: "Medication as a necessity and to feel well," "Frailty as a barrier for taking responsibility," "Patient autonomy and faith in authority" and "A wish for being involved." Most participants had not considered the possibility of deprescribing but were open towards medication change if proposed by a healthcare professional. Most participants did not have in‐depth knowledge about medication but would like to be informed or involved in decisions. The participants generally had faith in healthcare professionals despite limited contact. Our study implies that older adults with limited life expectancy and their relatives are generally interested in deprescribing activities; however, the initiative of deprescribing lies with the healthcare professionals. [ABSTRACT FROM AUTHOR]

Aims: The aim of this systematic review was to explore health care professionals' attitudes towards deprescribing in older people with limited life expectancy. Methods: A systematic literature search was conducted from inception to December 2017 using MEDLINE, EMBASE and CINAHL. Studies were included if they specifically concerned older people (≥65 years) with limited life expectancy, including those residing in any type of aged care facility, or were based on representative patient profiles. Results were analyzed inspired by the Joanna Briggs Institute's method for synthesis of qualitative data. Studies were characterized using a checklist for reporting of qualitative research. Results: Eight studies were included. Six studies explored health care professionals' views on deprescribing in general, and two studies focused specifically on psychotropic agents. All eight studies explored the views of physicians, mostly general practitioners, while three studies also considered other health care professionals. Four themes related to health care professionals' attitudes towards deprescribing were identified: (i) patient and relative involvement; (ii) the importance of teamwork; (iii) health care professionals' self‐assurance and skills; and (iv) the impact of organizational factors. Within each of these themes, 3–4 subthemes were identified and analysed. Conclusions: Our results suggest that health care professionals' decisions to engage in deprescribing activities with older people with limited life expectancy depend on multiple factors which are highly interdependent. Consequently, there is an urgent need for more research on how to approach deprescribing in clinical practice within this population. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Medication‐related problems are frequent and can lead to serious adverse events resulting in increased morbidity, mortality, and costs. Medication use in frail older patients is even more complex. The aim of this study was to investigate the effect of a pharmacist‐led medicines management model among older patients at admission, during inpatient stay and at discharge on medication‐related readmissions. Method: A randomized controlled trial conducted at the acute admission unit in a Danish hospital with acutely admitted medical patients, randomized to either a control group or one of two intervention groups. The intervention consisted of pharmacist‐led medication review and patient interview upon admission (intervention ED) or pharmacist‐led medication review and patient interview upon admission, medication review during inpatient stay, and medication report and patient counselling at discharge (intervention STAY). Results: In total, 600 patients were included. The pharmacist identified 920 medication‐related problems with 57% of the recommendations accepted by the physician. After 30 days, 25 patients had a medication‐related readmission, with no statistical significant difference between the groups on either primary or secondary outcomes. Conclusions: This study showed that a clinical pharmacist can be used to identify and solve medication‐related problems, but this study did not find any effect on the selected outcomes. The frequency of medication‐related readmissions was low, leaving little room for improvement. Future research should consider other study designs or outcome measures. [ABSTRACT FROM AUTHOR]

OBJECTIVES To summarize available tools that can assist clinicians in identifying and reducing or stopping (deprescribing) potentially inappropriate medications and that specifically consider frailty or limited life expectancy. DESIGN Systematic review and narrative synthesis. SETTING We searched MEDLINE (via Ovid SP), EMBASE (via Ovid SP), and CINAHL from inception to December 2017, along with grey literature. We included articles that described a tool to guide deprescribing of medications. PARTICIPANTS Frail older persons and older persons with limited life expectancy. MEASUREMENTS Narrative description of tools. RESULTS: We identified 15 tools and organized them into three main categories: tools (n = 2) that described a model or framework for approaching deprescribing, tools (n = 9) that outlined a deprescribing approach for the entire medication list, and tools (n = 4) that provided medication‐specific advice. The complexity of the tools ranged from simple lists to detailed, step‐wise protocols. The development methodology varied widely, and the methods used to synthesize the tools were generally not well described. Most tools were based on expert opinion. Only four of the 15 tools have been tested in clinical practice (in very low‐quality studies). CONCLUSION: Tools exist to help clinicians deprescribe in frail older persons and those with limited life expectancy. These tools may assist clinicians at various stages in the deprescribing process. However, it remains to be investigated whether use of such tools in practice is likely to improve clinical outcomes or reduce inappropriate medication use. J Am Geriatr Soc 67:172–180, 2019. [ABSTRACT FROM AUTHOR]

Abstract: Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist‐led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer‐reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient‐related multifaceted pharmacist‐led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi‐centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient‐reported outcome (n = 7) and cost‐effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist‐led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient‐reported outcome and cost‐effectiveness. [ABSTRACT FROM AUTHOR]

Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic Mini Review was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases ( MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100 interventions were included in the final assessment. A total of 836 research papers were identified, and 31 publications were included in the study: 21 descriptive studies and 10 controlled studies, of which 6 were randomized controlled trials. The pharmacist interventions were well implemented with acceptance rates from 39% to 100%. The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use. Several outcomes were statistically insignificant, but these were predominantly associated with low sample sizes or low acceptance rates. Therefore, future research within this area should be designed using rigorous design, large sample sizes and includes comparable outcome measures for patient health outcomes. [ABSTRACT FROM AUTHOR]