Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review.

Deprescriptions Humans Pharmacists Polypharmacy Primary Health Care
Behaviour change wheel Deprescribing Primary health care

Journal

Research in social & administrative pharmacy : RSAP
ISSN: 1934-8150
Titre abrégé: Res Social Adm Pharm
Pays: United States
ID NLM: 101231974

Informations de publication

Date de publication:
07 2021
Historique:
received: 09 03 2020
revised: 17 06 2020
accepted: 07 09 2020
pubmed: 27 9 2020
medline: 3 8 2021
entrez: 26 9 2020
Statut: ppublish

Résumé

Polypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review. This scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW). A scoping review was conducted that involved searches of six databases (2002-2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT). Searches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion. Deprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care.

Sections du résumé

BACKGROUND
Polypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review.
OBJECTIVE
This scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW).
METHODS
A scoping review was conducted that involved searches of six databases (2002-2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT).
RESULTS
Searches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion.
CONCLUSIONS
Deprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care.

Identifiants

DOI: 10.1016/j.sapharm.2020.09.005 PMID: 32978088
pubmed: 32978088
pii: S1551-7411(20)30227-8
doi: 10.1016/j.sapharm.2020.09.005
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1229-1241

Informations de copyright

Copyright © 2020 Elsevier Inc. All rights reserved.

Auteurs

Jennifer E Isenor (JE)

College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada. Electronic address: jennifer.isenor@dal.ca.

Isaac Bai (I)

College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada.

Rachel Cormier (R)

College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada.

Melissa Helwig (M)

W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada.

Emily Reeve (E)

College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada; Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada.

Anne Marie Whelan (AM)

College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada.

Sarah Burgess (S)

Pharmacy Department, Nova Scotia Health Authority, Halifax, NS, Canada.

Ruth Martin-Misener (R)

School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, Canada.

Natalie Kennie-Kaulbach (N)

College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Déprescriptions › Deprescribing interventions in primary health...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Deprescribing interventions in primary health...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Pharmaciens › Deprescribing interventions in primary health...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Attitude envers la santé › Mésusage des services de santé › Surmédicalisation › Traitement excessif › Polypharmacie › Deprescribing interventions in primary health...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Deprescribing interventions in primary health...