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Background: Medication discontinuation studies explore the outcomes of stopping a medication compared to continuing it. Comprehensively identifying medication discontinuation articles in bibliographic databases remains challenging due to variability in terminology. Objectives: To develop and validate search filters to retrieve medication discontinuation articles in Medline and Embase. Methods: We identified medication discontinuation articles in a convenience sample of systematic reviews. We used primary articles to create two reference sets for Medline and Embase, respectively. The reference sets were equally divided by randomization in development sets and validation sets. Terms relevant for discontinuation were identified by term frequency analysis in development sets and combined to develop two search filters that maximized relative recalls. The filters were validated against validation sets. Relative recalls were calculated with their 95% confidences intervals (95% CI). Results: We included 316 articles for Medline and 407 articles for Embase, from 15 systematic reviews. The Medline optimized search filter combined 7 terms. The Embase optimized search filter combined 8 terms. The relative recalls were respectively 92% (95% CI: 87–96) and 91% (95% CI: 86–94). Conclusions: We developed two search filters for retrieving medication discontinuation articles in Medline and Embase. Further research is needed to estimate precision and specificity of the filters. [ABSTRACT FROM AUTHOR]

Over the past decade, polypharmacy has increased dramatically. Measurable harms include falls, fractures, cognitive impairment, and death. The associated costs are massive and contribute substantially to low-value health care. Deprescribing is a promising solution, but there are barriers. Establishing a network to address polypharmacy can help overcome barriers by connecting individuals with an interest and expertise in deprescribing and can act as an important source of motivation and resources. Over the past decade, several deprescribing networks were launched to help tackle polypharmacy, with evidence of individual and collective impact. A network approach has several advantages; it can spark interest, ideas and enthusiasm through information sharing, meetings and conversations with the public, providers, and other key stakeholders. In this special report, the details of how four deprescribing networks were established across the globe are detailed. Networks create links between people who lead existing and/or budding deprescribing practices and policy initiatives, can influence people with a shared passion for deprescribing, and facilitate sharing of intellectual capital and tools to take initiatives further and strengthen impact. This report should inspire others to establish their own deprescribing networks, a critical step in accelerating a global deprescribing movement. [ABSTRACT FROM AUTHOR]

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This article discusses the importance of empowering people living with dementia to be active partners in conversations about their medications. The authors describe their process of co-designing a conversation tool called the PRIME tool, which stands for "PReparing people living with dementia and their carers to Initiate deprescribing conversations about Medications." The tool is designed to provide subtle cues to healthcare professionals to review the ongoing need for medications during shared decision-making consultations. The authors reflect on their partnership with a stakeholder group consisting of consumers and healthcare professionals and provide recommendations for engaging stakeholders in the co-design process. They hope that their findings will inform the development of impactful deprescribing research resources alongside consumer groups. [Extracted from the article]

Deprescribing is the process of stopping medication that may no longer be necessary or is causing harm. There has been a significant amount of research on deprescribing in the past decade, covering topics such as deprescribing rates, barriers and facilitators, and interventions. A group of deprescribing experts compiled a list of ten articles that provide a diverse overview of the field for newcomers. The articles cover critical concepts, high-level overviews, major trials, the complexity of deprescribing, and knowledge synthesis in deprescribing. While the list is not exhaustive, it serves as a starting point for those interested in learning about deprescribing. [Extracted from the article]

Deprescribing is the process of withdrawing medications when the harms outweigh the benefits, supervised by a healthcare professional. The field of deprescribing research has emerged to address healthcare issues such as polypharmacy and inappropriate medication use. Pharmacoepidemiology has been instrumental in establishing these problems, showing that polypharmacy is increasing and potentially inappropriate medication use is common, especially among older adults. Qualitative and quantitative research has explored the barriers, enablers, and attitudes towards deprescribing from various stakeholders. Tools and resources have been developed to support deprescribing in practice, including evidence-based guidelines. Research has also focused on the clinical outcomes of deprescribing specific medications and optimizing deprescribing through interventional and implementation studies. While there has been significant expansion in deprescribing research, there are still gaps and further research is needed. [Extracted from the article]

Deprescribing aims to address the problem of medication overuse in older adults. There has been an increasing number of systematic reviews of 'deprescribing'. We aimed to describe the categories of trials included in recent systematic reviews, and to make recommendations for future research. We categorized 122 trials included in eight recent deprescribing systematic reviews into: discontinuation, deprescribing implementation, medication optimisation (including medication initiation) and non‐initiation trials. We identified heterogeneity and inconsistency in the categories of trials included in deprescribing systematic reviews. For example, 39 trials (32.0%) involved medication initiation in addition to the deprescribing component. It is now time for international researchers to develop and validate terminology used for trials involving discontinuation/deprescribing of medications, and to provide recommendations for evidence synthesis that will better inform future research, and translation into practice and policy. [ABSTRACT FROM AUTHOR]

Deprescribing is the process of reducing or stopping medications when they are unnecessary, have more harm than benefit, or do not align with healthcare goals. The field of deprescribing has grown rapidly in the past decade due to the global problem of medication overuse. The first International Conference on Deprescribing (ICOD) was held in Denmark in September 2022, bringing together 250 participants from around the world. This special issue contains 25 papers that cover a range of topics related to deprescribing, including research, patient/provider communication, knowledge synthesis, deprescribing interventions, patient perspectives, interprofessional collaboration, and real-world deprescribing patterns. The papers aim to inspire and inform further growth and innovation in the field of deprescribing. [Extracted from the article]

The article presents a study which examined rates of overtreatment and deprescribing of antihyperglycemics at urban long-term care (LTC) facilities in British Columbia. Topics include data extracted for all residents, baseline characteristics of cohort, and results which suggest that overtreatment of type 2 diabetes (T2DM) continues to occur in LTC.

Background Shared decision-making (SDM) incorporates people's individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that are a good fit for them as individuals. Methods We conducted a pilot study to understand experiences of two LTC homes in Ontario as they tested implementing SDM resources to support medication decisions. LTC homes conducted two Plan-Do-Study-Act (PDSA) cycles supported by an Advisory Group composed of LTC home representatives and stakeholders involved in resource design. Rapid qualitative analysis of transcripts and field notes from Advisory Group meetings elucidated how SDM resources were used. Results Each site was positively engaged but implemented resources differently. The pharmacist and physicians at Site 1 introduced proton-pump inhibitor (PPI) deprescribing as their primary intervention, identifying suitable residents, informing residents and families of the deprescribing process, and providing selected SDM resources to residents, caregivers and staff. Representatives reported limited engagement with SDM resources and difficulty measuring the impact of PPI deprescribing. Representatives from Site 2 disseminated the SDM resources to residents and caregivers for use at care conferences and focused on front-line staff education and involvement. This site reported that some residents/caregivers were interested in participating in SDM and using the resources, while others were not. The impact of the resources on SDM at this site was unclear. Conclusions Within the context of LTC, further research is needed to clarify the meaning and importance of SDM in medication decision-making. Implementation of SDM will likely require a multi-faceted approach. [ABSTRACT FROM AUTHOR]

Background Long-term preventive treatment such as treatment with statins should be reassessed among patients approaching end of life. The aim of the study was to describe the rate of discontinuation of statin treatment and factors associated with discontinuation in the 6 months before death. Methods This study is a retrospective cohort study using national registers and blood test results from primary health care patients. Patients in the Copenhagen municipality, Denmark who died between 1997 and 2018 and were statin users during the 10-year period before death were included. We calculated the proportion who remained statin users in the 6-month period before death. Factors associated with discontinuation were tested using logistic regression. Results A total of 55,591 decedents were included. More patients continued treatment (64%, n = 35,693) than discontinued (36%, n = 19,898) the last 6 months of life. The 70 and 80 age groups had the lowest odds of discontinuing compared to the 90 (OR 1.59, 95% CI 0.93–2.72) and 100 (OR 3.11, 95% CI 2.79–3.47) age groups. Increasing comorbidity score (OR 0.89, 95% CI 0.87; 0.90 per 1-point increase) and use of statins for secondary prevention (OR 0.89, 95% CI 0.85; 0.93) reduced the likelihood of discontinuation as did a diagnosis of dementia, heart failure, or cancer. Conclusion A substantial portion of patients continued statin treatment near end of life. Efforts to promote rational statin use and discontinuation are required among patients with limited life expectancy, including establishing clear, practical recommendations about statin discontinuation, and initiatives to translate recommendations into clinical practice. [ABSTRACT FROM AUTHOR]

Background: Proton pump inhibitors (PPIs) contribute to polypharmacy and are associated with adverse effects. As prospective data on longitudinal patterns of PPI prescribing in older patients with multimorbidity are lacking, we sought to assess patterns of PPI prescribing and deprescribing, as well as the association of PPI use with hospital admissions over 1 year in this population. Methods: We conducted a prospective, longitudinal cohort study using data from the Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM) trial, a randomized controlled trial testing an intervention to reduce inappropriate prescribing (2016–2018). This trial included adults aged 70 years and older with at least 3 chronic conditions and prescribed at least 5 chronic medications. We assessed prevalence of PPI use at time of hospital admission, and new prescriptions and deprescribing at discharge, and at 2 months and 1 year after discharge, by intervention group. We used a regression with competing risk for death to assess the association of PPI use with readmissions related to their potential adverse effects, and all-cause readmission. Results: Overall, 1080 (57.4%) of 1879 patients (mean age 79 yr) had PPI prescriptions at admission, including 496 (45.9%) patients with a potentially inappropriate indication. At discharge, 133 (24.9%) of 534 patients in the intervention group and 92 (16.8%) of 546 patients in the control group who were using PPIs at admission had deprescribing. Among 680 patients who were not using PPIs at discharge, 47 (14.6%) of 321 patients in the intervention group and 40 (11.1%) of 359 patients in the control group had a PPI started within 2 months. Use of PPIs was associated with all-cause readmission (n = 770, subdistribution hazard ratio 1.31, 95% confidence interval 1.12–1.53). Interpretation: Potentially inappropriate use of PPI, new PPI prescriptions and PPI deprescribing were frequent among older adults with multimorbidity and polypharmacy. These data suggest that persistent PPI use may be associated with clinically important adverse effects in this population. [ABSTRACT FROM AUTHOR]

Background: Deprescribing (planned, supervised discontinuation) of statins may be considered in some older persons. This should be carefully discussed between patients and GPs.Methods: We examined GPs' preferences for discussing statin deprescribing by conducting a discrete choice experiment (DCE) sent to a stratified random sample of 500 Danish GPs. Attributes were discussion topics (goals of therapy, evidence on statin use in older persons, adverse effects, uncertainty), and levels were the depth of the discussion topics (none, brief, detailed). We used mixed logistic regression for analysis.Results: A total of 90 GPs (mean age 48, 54% female, mean 11 years in practice) completed the DCE. There was substantial variability in which topics GPs felt were most important to discuss; however, GPs generally preferred a brief discussion of topics to detailed ones. The most important discussion topic appeared to be goals of therapy. GPs felt a brief discussion of evidence was important but not a detailed one, while adverse effects and uncertainty were felt to be less important to discuss.Conclusion: GPs prefer brief discussions on a range of topics when discussing statin deprescribing but have differing views on which topics are most important. For deprescribing communication tools to be useful to GPs in clinical practice, they may need to focus on brief coverage of the range of relevant topics. Future work should evaluate patient preferences, and opportunities for education and training for GPs on deprescribing communication. [ABSTRACT FROM AUTHOR]

The article presents the discussion on proton pump inhibitor (PPI). Topics include clinical trials, the most common adverse events being diarrhea, headache, constipation, and abdominal pain; and Vermeulen Windsant-van den Tweel and colleagues found that PPIs being associated with an increased risk of hypomagnesemia.

Purpose: To examine use of sedating medications around the time of nursing home admission in Denmark. Methods: We conducted a register‐based drug utilization study, describing patterns of commonly used medications with sedative effects leading up to and after nursing home admission using data from 94 Danish nursing homes between 2015 and 2017. Results: We identified 5179 residents (median age 84 years, 63% female) and described monthly incidence and total use of benzodiazepines (BZDs), Z drugs, mirtazapine/mianserin, quetiapine, promethazine, and melatonin. The proportion of unique users of sedating medications was similar before and after admission (42% before vs. 40% after) despite an increase in total use after admission. The overall incidence of sedating medications peaked in the 6 months before and 6 months after admission (peaking at 4.6 per 100 person‐months 1 month after admission). The most commonly initiated medications were mirtazapine/mianserin, followed by BZDs and Z drugs. Total use of sedating medications increased leading up to admission (peaking at 1001 defined daily doses per 100 residents per month 1 month after admission) and decreased gradually after admission. Conclusions: Sedative medication initiation increases sharply leading up to admission in Danish nursing homes. Mirtazapine/mianserin is a commonly used agent in nursing homes, despite limited evidence on benefits and harms. Efforts to promote rational use of these medications in nursing homes remain warranted. [ABSTRACT FROM AUTHOR]