Search

This is a protocol for a scoping review to map out the available evidence on how the term ‘prescribing cascade’ has been defined or conceptualised in published journal articles.

The purpose of this scoping review is to identify what has been reported in observational studies on the effects of antirheumatic medication use during pregnancy.

INTRODUCTION Rationale: Being discharged from hospital may include the need to acquire new or current medications from the community pharmacy; often a challenge for either the patient or caregiver to attain. “Meds to Beds” is a care model that delivers discharge medications and related education to hospitalized patients or their caregivers prior to discharge. This care model aims to relieve some of the challenges for patients and caregivers in attaining needed medication which may improve adherence to post-hospital treatment. Meds to Beds has been implemented in various ways in the United States and is being integrated into select centres in Canada. A rapid review of the literature on this care model is useful in designing, implementing, and evaluating our own program by canvassing promising practices from other programs and identifying gaps in existing research to identify opportunities for future studies. Objective: To describe and categorize studies of “Meds to Beds” programs (provision of discharge medications to soon to be or newly discharged (within 24 hours) patients) in terms of study design, intervention elements, outcomes examined, reported implementation barriers and facilitators. This rapid scoping review will address the research question: “What does existing literature report about “Meds to Beds” care models in terms of study designs, intervention elements, outcomes examined, implementation barriers and facilitators?”

Background: Multiple sclerosis (MS) is an autoimmune disease that is often treated with multiple medications. Managing multiple medications, also known as polypharmacy, can be challenging for persons with MS. Toolkits are instructional resources designed to promote behaviour change. Toolkits may support medication self-management for adults with MS, as they have been useful in other populations with chronic conditions. Objective: The main purpose of this review was to identify and summarize medication self-management toolkits for MS, as related to the design, delivery, components, and measures used to evaluate implementation and/or outcomes. Methods: A scoping review was conducted following guidelines by JBI. Articles were included if they focused on adults (18 years or older) with MS. Results: Six articles reporting on four unique toolkits were included. Most toolkits were technology-based, including mobile or online applications, with only one toolkit being paper-based. The toolkits varied in type, frequency, and duration of medication management support. Varying outcomes were also identified, but there were improvements reported in symptom management, medication adherence, decision-making, and quality of life. The six studies were quantitative in design, with no studies exploring the user experience from a qualitative or mixed-methods design. Conclusions: There is limited research on medication self-management toolkits among adults with MS. Future development, implementation, and evaluation mixed-methods research are needed to explore user experiences and overall design of toolkits.

IntroductionIndividuals who take medications regularly may experience challenges with making decisions about risks versus benefits, managing side effects, and integrating medication management with other aspects of life such as social and work responsibilities. However, existing medication self-management frameworks are primarily adherence-focused and lack a holistic perspective. This study aimed to explore what Canadian adults, with experience taking daily medication, can contribute to our understanding of medication self-management.MethodsConcept mapping is a participatory action research approach with three stages: brainstorming, sorting/rating, and mapping. During brainstorming, group discussions were held with participants who generated statements about what matters to them regarding medications in their everyday lives. In sorting/rating, participants individually grouped statements into thematic piles and rated their importance and feasibility. During mapping, a group discussion was held where a subset of participants agreed on a visual map and named the clusters of statements. Following mapping, rating results were analysed and compared by participant characteristics (gender, age, duration of medication use, number of medications and chronic conditions).ResultsSixty-three participants generated 1044 statements during the brainstorming sessions (n=8), which we synthesized into 94 statements. Statements identified priorities related to medication administration, social impact, and healthcare provider interactions. Fifty-four participants sorted the statements and rated their importance and feasibility. Regardless of participant characteristics, most statements were rated highly on both importance and feasibility. Eight participants attended the final mapping session. The final map had nine thematic clusters of what mattered to individuals about their medications: 1) researching and becoming educated about medications, 2) social support, 3) effectiveness of medication, 4) self-ownership of medication, 5) ease of use, 6) convenience and accessibility, 7) information provided by healthcare provider, 8) personal interactions with healthcare providers, and 9) patient involvement and trust. DiscussionsParticipants generated themes that contribute to our understanding of medication self-management and highlight complexities that extend beyond medication adherence (e.g., social support, shared decision-making). Participants’ perceived statements as highly important and feasible, and thus actionable to inform interventions to support self-management and improve medication experiences.ConclusionsOur results complement and enhance existing self-management frameworks and provide a more holistic perspective than adherence-focused research.Lessons LearnedWe need a more holistic approach, that moves beyond adherence, to research experiences with medication management. There is value in health professionals understanding experiences with managing medication from a holistic lens, especially within integrated care models, to support self-management through person-centered medication education, prescribing, and counselling.LimitationsWe experienced some challenges as this study was conducted during the COVID-19 pandemic. Participant recruitment and data collection had to be done online, with virtual group discussions, to adhere to physical distancing guidelines. Perspectives of persons unable to access and participate in online sessions may differ from our sample.Suggestions For Future ResearchStudies on medication self-management in more specific populations (e.g., older adults) should be done to extend the generalizability of our findings. Medication self-management should also be explored from the perspective of healthcare providers to probe whether and how patient and provider priorities may differ.

Shawn Varghese,1– 3 Shoshana Hahn-Goldberg,1,4 ZhiDi Deng,1 Glyneva Bradley-Ridout,1,5 Sara JT Guilcher,1,6 Lianne Jeffs,6– 8 Craig Madho,4 Karen Okrainec,9 Zahava RS Rosenberg-Yunger,10 Lisa M McCarthy1,2,11,12 1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; 2Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada; 3Michael G.Degroote School Of Medicine, McMaster University, Hamilton, Ontario, Canada; 4OpenLab, University Health Network, Toronto, Ontario, Canada; 5Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada; 6Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; 7Sinai Health, Toronto, Ontario, Canada; 8Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; 9Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada; 10Ted Rogers School of Management, School of Health Services Management, Ryerson University, Toronto, Ontario, Canada; 11Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 12Institute for Better Health, Trillium Health Partners, Mississauga, ON, CanadaCorrespondence: Lisa M McCarthy, Clinician Scientist, Institute for Better Health, Trillium Health Partners, Tel +1 416-566-2793, Email lisa.mccarthy@utoronto.caPurpose: Transitions in care (TiC) often involves managing medication changes and can be vulnerable moments for patients. Medication support, where medication changes are reviewed with patients and caregivers to increase knowledge and confidence about taking medications, is key to successful transitions. Little is known about the optimal tools and processes for providing medication support. This study aimed to identify describe patient or caregiver-centered medication support processes or tools that have been studied within 3 months following TiC between hospitals and other care settings.Methods: Rapid scoping review; English-language publications from OVID MEDLINE, OVID EMBASE, Cochrane Library and EBSCO CINAHL (2004-July 2019) that assessed medication support interventions delivered within 3 months following discharge were included. A subset of titles and abstracts were assessed by two reviewers to evaluate agreement and once reasonable agreement was achieved, the remainder were assessed by one reviewer. Eligibility assessment for full-text articles and data charting were completed by an experienced reviewer.Results: A total of 7671 unique citations were assessed; 60 studies were included. Half of the studies (n = 30/60) were randomized controlled trials. Most studies (n = 45/60) did not discuss intervention development, particularly whether end users were involved in intervention design. Many studies (n = 37/60) assessed multi-component interventions with written/print and verbal education components. Few studies (n = 5/60) included an electronic component. Very few studies (n = 4/60) included study populations at high risk of adverse events at TiC (eg, people with physical or intellectual disabilities, low literacy or language barriers).Conclusion: The majority of studies were randomized controlled trials involving verbal counselling and/or physical document delivered to the patient before discharge. Few studies involved electronic components or considered patients at high-risk of adverse events. Future studies would benefit from improved reporting on development, consideration for electronic interventions, and improved reporting on patients with higher medication-related needs.Keywords: continuity of patient care, patient discharge, patient education, rapid scoping review, medication counseling, care transitions

Lauren Cadel,1,2 Stephanie R Cimino,3,4 Teagan Rolf von den Baumen,1 Kadesha A James,1 Lisa McCarthy,1,2,5 Sara JT Guilcher1,3,6 1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; 2Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; 3Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; 4St. John’s Rehab, Sunnybrook Health Sciences Centre, North York, Ontario, Canada; 5Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada; 6Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Sara JT GuilcherLeslie Dan Faculty of Pharmacy, 144 College Street, Room 604, Toronto, ON, M5S 3M2, CanadaTel + 1-416-946-7020Email sara.guilcher@utoronto.caPurpose: Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management.Methods: Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review.Results: About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management.Conclusion: Medication self-management is a complex process and often impacts multiple areas of an individual’s life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains – medical, emotional and role management.Keywords: medication therapy management, self-management, framework, model, review

Additional file 1. Interview guides. The guide used to interview participants.

A World Café workshop was held at the Bruyère Evidence-Based Deprescribing Guidelines Symposium in March 2018 with 30 participants (researchers, clinicians, policy makers, stakeholders). This workshop explored priorities for future work in the field of deprescribing and deprescribing guidelines through group discussion. The discussions were guided by the following questions: (1) What are deprescribing research priorities (to inform guideline development), (2) What outcome measures are important for developing deprescribing guidelines, and (3) How do we evaluate the implementation and effectiveness of deprescribing guidelines? Discussion from all 3 questions identified 6 main priority areas: (1) conducting high-quality and long-term clinical trials that measure patient-important outcomes, (2) focusing on patient involvement and perspectives, (3) investigating the pharmacoeconomics of deprescribing interventions, (4) understanding deprescribing interventions in different populations, (5) generating evidence on clinical management during deprescribing (e.g. managing adverse drug withdrawal effects, subsequent re-prescribing), and (6) implementing interventions in clinical practice. These topics represent what a group of experienced researchers, clinicians, and stakeholders in the field collectively felt was important to consider for design and implementation of future deprescribing studies. The aim is for these findings to stimulate future discussions and be considered by granting agencies, policy makers, deprescribing research networks, and individual researchers planning future deprescribing studies.

Supplemental material, 882969_appendix_3_online_supp for Community pharmacists as catalysts for deprescribing: An exploratory study using quality improvement processes by Barbara Farrell, Chantalle Clarkin, James Conklin, Lisa Dolovich, Hannah Irving, Lisa McCarthy and Lalitha Raman-Wilms in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Supplemental material, 882969_appendix_5_online_supp for Community pharmacists as catalysts for deprescribing: An exploratory study using quality improvement processes by Barbara Farrell, Chantalle Clarkin, James Conklin, Lisa Dolovich, Hannah Irving, Lisa McCarthy and Lalitha Raman-Wilms in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Supplemental material, 882969_appendix_2_online_supp for Community pharmacists as catalysts for deprescribing: An exploratory study using quality improvement processes by Barbara Farrell, Chantalle Clarkin, James Conklin, Lisa Dolovich, Hannah Irving, Lisa McCarthy and Lalitha Raman-Wilms in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Supplemental material, 815717_App_2_online_supp for Pharmacy in the 21st century: Enhancing the impact of the profession of pharmacy on people’s lives in the context of health care trends, evidence and policies by Lisa Dolovich, Zubin Austin, Feng Chang, Barbara Farrell, Kelly Grindrod, Sherilyn Houle, Lisa McCarthy, Lori MacCallum and Beth Sproule in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Supplemental material, 815717_App_1_online_supp for Pharmacy in the 21st century: Enhancing the impact of the profession of pharmacy on people’s lives in the context of health care trends, evidence and policies by Lisa Dolovich, Zubin Austin, Feng Chang, Barbara Farrell, Kelly Grindrod, Sherilyn Houle, Lisa McCarthy, Lori MacCallum and Beth Sproule in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Supplemental material, 778301_App_1_online_supp for Exploring deprescribing opportunities for community pharmacists: Protocol for a qualitative study by Clara Korenvain, Linda MacKeigan, Katie Dainty, Sara J. T. Guilcher and Lisa McCarthy in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Interim OPEN Member Survey and Interview Guide. (DOC 82 kb)

Interview Guide. Question used for interviewing participants. (DOCX 12Â kb)

Additional file 1. Brief Community Pharmacist Survey – Full Intervention.

Interview Guide. Question used for interviewing participants. (DOCX 12Â kb)

Additional file 1. Brief Community Pharmacist Survey – Full Intervention.

Additional file 1. Brief Community Pharmacist Survey – Full Intervention.

A World Café workshop was held at the Bruyère Evidence-Based Deprescribing Guidelines Symposium in March 2018 with 30 participants (researchers, clinicians, policy makers, stakeholders). This workshop explored priorities for future work in the field of deprescribing and deprescribing guidelines through group discussion. The discussions were guided by the following questions: (1) What are deprescribing research priorities (to inform guideline development), (2) What outcome measures are important for developing deprescribing guidelines, and (3) How do we evaluate the implementation and effectiveness of deprescribing guidelines? Discussion from all 3 questions identified 6 main priority areas: (1) conducting high-quality and long-term clinical trials that measure patient-important outcomes, (2) focusing on patient involvement and perspectives, (3) investigating the pharmacoeconomics of deprescribing interventions, (4) understanding deprescribing interventions in different populations, (5) generating evidence on clinical management during deprescribing (e.g. managing adverse drug withdrawal effects, subsequent re-prescribing), and (6) implementing interventions in clinical practice. These topics represent what a group of experienced researchers, clinicians, and stakeholders in the field collectively felt was important to consider for design and implementation of future deprescribing studies. The aim is for these findings to stimulate future discussions and be considered by granting agencies, policy makers, deprescribing research networks, and individual researchers planning future deprescribing studies. Refereed/Peer-reviewed