Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons
Salas, Roxana De Las (National University of Colombia. Department of Pharmacy)
Eslava-Schmalbach, J. (National University of Colombia. Department of Public Health)
Vaca-González, Claudia (National University of Colombia. Department of Pharmacy)
Rodríguez Cumplido, Dolores (Universitat Autònoma de Barcelona. Departament de Farmacologia, de Terapèutica i de Toxicologia)
Figueras, Albert 1961- (Universitat Autònoma de Barcelona. Departament de Farmacologia, de Terapèutica i de Toxicologia)

Fecha:	2020
Resumen:	The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons. We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity ratio, item-level content validity, and Fleiss' Kappa statistics was measured to establish reliability. The same voting method was used for round 2. A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0. 77 (95% CI 0. 60-0. 93), for domains with Kappa= 0. 73 (95%CI 0. 60-0. 86) and for decisions with Kappa= 0. 97 (95%CI 0. 90-1. 00). This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient's and caregiver's preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons' medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice.
Nota:	Funding: The deprescribing tool was supported by Colciencias contract (110177758303 CT-792-2018) and Doctoral Fellowship Program 647-2015
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Deprescriptions ; Polypharmacy ; Inappropriate Prescribing ; Clinical Decision-Making ; Algorithms ; Pharmacists ; General Practitioners ; Geriatricians ; Physicians, Family ; Consensus ; Delphi Technique ; Validation Studies as Topic ; Colombia
Publicado en:	Pharmacy Practice, Vol. 18 Núm. 4 (december 2020) , ISSN 1886-3655

DOI: 10.18549/PharmPract.2020.4.2033
PMID: 33343769

7 p, 809.7 KB

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