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Patients' safety can be compromised in the transition of care between healthcare sectors. Optimal information flow across healthcare sectors and individualized medication treatment tailored to each patient is vital to prevent adverse events like drug-related problems. When medication changes are made during hospitalization, it is essential to ensure that the relevant general practitioner (GP) is included in the communication chain. This randomized controlled trial examines the effect of a Medication Coordinator who facilitates medication reviews in close collaboration with patients using My Medication Plan. Patients in the intervention group receive the medication review in combination with including suggested medication amendments documented in their electronic discharge letter send, which is sent to their GP. The patients randomized to the control group receive standard care by the ward staff. Seventy patients from the Endocrinology and Nephrology Unit at the Hospital Sønderjylland will be included in the intervention and control groups, respectively. The primary outcome is the proportion of potentially inappropriate medications. Secondary outcomes include patient-reported outcomes, i.e., quality of life and medication burden. Additional outcomes include the patient's medication risk score, whether the patient is readmitted, and whether the patient has contacted the staff at the hospital unit after the hospital discharge. The framework for complex intervention is applied, because it allows flexibility and adaption in meeting patients' needs by implementing tailored, possibly complex interventions in different healthcare settings. This project will examine a particular piece in the puzzle of the complexity of conducting a medication review and communication of suggested medication amendments to the patients, healthcare at the hospital, and the GP. Hopefully, this can contribute to a reduction in the risk of potentially inappropriate post-hospital medication usage. Trial registration: The study has been registered at ClinicalTrial.gov with the registration number: NCT06383364. https://clinicaltrials.gov/study/NCT06383364. [ABSTRACT FROM AUTHOR]

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]

Background and Objectives Deprescribing may be particularly relevant in older people with limited life expectancy. In order to effectively carry out deprescribing in this population, it is important to understand the perspectives of the full spectrum of health care professionals (HCPs) involved in the management of these patients' medication. Thus, we aimed to explore different HCPs' perspectives on deprescribing in older patients with limited life expectancy. Research Design and Methods Six qualitative focus group interviews were conducted using a semistructured approach. The groups comprised HCPs from both primary and secondary care, including family physicians (FPs), geriatricians, clinical pharmacologists, clinical pharmacists, nurses, and health care assistants. Interviews were audio recorded and transcribed verbatim. Results were analyzed using systematic text condensation. Results A total of 32 HCPs participated in the study (median age of 40.5 years; 22% male). The analysis elicited three main themes related to HCPs' perspectives on deprescribing in older patients with limited life expectancy: (a) Approaching deprescribing, (b) Taking responsibility, and (c) Collaboration across professions. Within themes, subthemes were identified and analyzed. Discussion and Implications Our results imply that different groups of HCPs consider deprescribing an essential aspect of providing good care for older people with limited life expectancy and find that all HCPs play a crucial role in the deprescribing process, with FPs having the primary responsibility. In order to facilitate deprescribing among this population, however, the collaboration between different HCPs should be improved. [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]