Stopping Medication Research Articles

PRIORITIES ALIGNED DEPRESCRIBING FOR PERSONS LIVING WITH DEMENTIA AND THEIR CARE PARTNERS

Abstract PlwD average 8 daily medications compared to 3 for persons without dementia. PlwD have high polypharmacy burden from anticholinergic and psychotropic medications. PlwD, their care partners and clinicians endure the workload of managing multiple medications, and want to decrease this burden. Thus, a shift that reduces polypharmacy, and focuses medication use on what matters most is needed. Deprescribing is an approach to reduce polypharmacy for PlwD. However, deprescribing studies for PlwD have a narrow scope. Few studies place deprescribing within ambulatory care contexts for patients with mild to moderate dementia. Appropriate deprescribing in dementia requires identifying health priorities. Deprescribing is most appropriate when guided by priorities of patients and care partners. Patient Priorities Care (PPC) is an evidence-based approach to health priorities aligned decision making. We found evidence that PPC facilitates deprescribing by identifying health priorities that are misaligned with current medications. When used in the care of PlwD and their care partners, PPC could facilitate deprescribing. Less is known about how PPC works in the triadic context of clinician, care partner, and PlwD. Care partners may have concerns about stopping medications considered inappropriate such meds help manage symptoms. Clinicians may focus on cognitive and functional harms of medications without considering tradeoffs of stopping medications. Without eliciting priorities, families and care partners of PlwD may make decisions to stop medication without communication with their clinicians. We recently completed a study using PPC to deprescribe unnecessary medications among PlwD. We will discuss our findings and the implications for future work.

OLDER ADULTS’ PERCEPTION TOWARD DEPRESCRIBING INAPPROPRIATE MEDICATIONS

Abstract Introduction Inappropriate prescription of medications is a problem of growing interest in geriatrics. Initiatives have been ongoing to evaluate interventions targeting the hazards of inappropriate prescription of medications; Deprescribing is one of these initiatives. However, no current study has examined medicine-related perceptions toward deprescribing inappropriate medications among older adults. Methods A convenience sample of older adults who regularly visited the outpatient clinics during July 2023 for regular checkups were recruited. Data were collected by a graduate nursing student from one pharmacy located in a public hospital, five days per week, via in-person interviews using the Patient’s Perceptions of Deprescribing survey. Results The study found that older adults’ perceived interest in stopping medications, belief about medicine overuse, the unimportance of medicines, and medication concerns are significantly associated with a variety of sociodemographic (e.g., age), clinical (e.g., comorbidities), and PCP-related factors (e.g., knowledge of medications). Conclusion Inappropriate prescription of medication is one of the most common polypharmacy-related issues among older adults. The current study reported its findings on medicine-related perception toward deprescribing inappropriate medications among older adults. Care providers should discuss the benefits of deprescribing inappropriate medications with their patients to prevent the side effects associated with long-term unnecessary use. The long-term use of inappropriate medications by older adults should be carefully evaluated. Future studies on the effectiveness of an evidence-based deprescribing protocol on minimizing the clinical side effects associated with inappropriate prescription of medications among older adults are recommended.

Effectiveness of the Rapid Eye Movement Sequential Therapy Program in Reducing Post-Traumatic Stress Disorders in Individuals with Obsessive-Compulsive Disorder: A Sample of Mothers of Children with Special Needs Referred from Psychological Clinics in Kha

The study aimed to reveal the effectiveness of the Rapid Eye Movement Desensitization and Reprocessing (EMDR) program in reducing post-traumatic stress disorder among patients with obsessive-compulsive disorder (among a sample of mothers of children with special needs referred from psychiatric clinics in Khartoum). The study sample consisted of (14) mothers, who were intentionally selected from those attending psychiatric clinics in Khartoum, and suffering from obsessive-compulsive disorder as a result of post-traumatic stress disorder after being informed that their children have special needs. Their ages ranged between (35-40) years. Participation in the treatment program was approved based on the psychiatrists' orientations for them to attend the program to complete treatment after stopping medication. The Yale-Brown Obsessive Compulsive Scale was used and applied to the study sample before and after the program, as well as during follow-up. To achieve the study objectives, the EMDR program was applied to reduce post-traumatic stress disorder symptoms. It was prepared by the researcher and lasted for two months from January 1st (2023) until the end of February of the same year. The researcher applied the study tools before and after the program. The data was analyzed using the Statistical Package for Social Sciences (SPSS). The study reached the following results: The first hypothesis indicated statistically significant differences at the significance level (α=0.05) in obsessive thoughts among the study sample between the pre-test and post-test due to the EMDR program. The training program showed an effectiveness of (74.7%) in reducing their obsessive thoughts. The result of the second hypothesis also indicated statistically significant differences at the significance level (α=0.05) in compulsive acts among the sample between the pre-test and post-test, attributed to the EMDR program. The training program showed an effectiveness of (74.9%) in reducing the compulsive acts associated with post-traumatic stress disorder among the sample. The follow-up results indicated no statistically significant differences at the significance level (α=0.05) in obsessive thoughts among the sample between the post-test and follow-up test. There were also no statistically significant differences at the significance level (α=0.05) in compulsive acts among the sample between the post-test and follow-up test, indicating the effect and continued effectiveness of the training program during the follow-up stage. In light of these results, the study recommended conducting further studies on the effectiveness of the EMDR program in reducing post-traumatic stress disorder symptoms in patients with obsessive-compulsive disorder with a sample of males or other age groups to reduce their obsessive-compulsive acts.

Augmented Reality in Ward Round-Based Simulation: Exploring Student Experiences and Impact on Confidence.

Doctors in training make substantial contributions to ward rounds. Despite this, formal education in this area is lacking, leading to diminished confidence and competence among undergraduate students and trainees. Ward round-based simulation (WRBS) has shown promise in improving clinical and decision-making skills.This quasi-experimental mixed-methods study aims to explore student experiences of augmented reality (AR) in simulated medical ward rounds. Specifically, it seeks to compare AR to existing traditional simulation modalities (TSM), manikin, and actor, to evaluate its viability as an alternative and to explore the impact of amixed-modality simulated ward roundon student confidence levels in performing ward round tasks. Fourteen participants engaged in a simulated ward round involving three cases: an actor as a patient, a manikin, and an AR case. Guided by pre- and post-simulation questionnaires, confidence levels around WRBS were explored using Wilcoxon's signed-rank test. Additionally, thematic analysis of semi-structured focus groups explored the use of AR in simulation compared to TSM. Significant improvements in confidence shown through the pre- and post-simulation questionnaires (p < 0.019) were found using Wilcoxon's signed-rank test across all 11 questions, with effect sizes (r) ranging from 0.65 to 0.9. The highest effect size observed (r = 0.9) asked about the change in confidence when starting or stopping medications during a ward round (p = 0.002). Qualitative analysis of focus group discussions identified key themes such as the visual accuracy of AR, the need for interactivity, and the cognitive load of mixed-method simulations. The findings suggest that AR can significantly enhance medical training by providing realistic and immersive learning experiences, although further refinements are necessary to improve interactivity and reduce cognitive demands. This study highlights the potential for integrating innovative technologies to better prepare students for clinical practise and provides further insight into the practicalities of using AR in medical education.

Predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adult outpatients in Jordan: a cross-sectional study

ObjectivesTo examine the predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adults in Jordan.DesignA cross-sectional, correlational study.SettingData were collected by a graduate nursing student from five outpatient clinics...

Sustainability of health outcomes of patients with type-2 diabetes mellitus after completing 6 months of remote tele-monitoring: Two-year results from a randomised controlled trial (OPTIMUM).

Meta-analysis shows that home tele-monitoring (HTM) improves glycaemic control in patients with type-2 diabetes mellitus (T2DM) up to 12 months, but their health outcomes after HTM cessation remains unclear. This study aimed to determine the health outcomes of these patients 18 months after completing 6 months of HTM, compared to standard care. Patients with T2DM were enrolled in an open-labelled randomised controlled trial, aged 26 to 65 years, and suboptimal glycaemic control (HbA1c = 7.5%-10%). Patients in the intervention group (n = 165) undertook HTM using the OPTIMUM (Optimising care of Patients via Telemedicine In Monitoring and aUgmenting their control of diabetes Mellitus) HTM system for 6 months followed by usual care for another 18 months, while control group (n = 165) had usual care for 24 months. The OPTIMUM HTM system includes in-app video-based tele-education, tele-monitoring of the blood pressure (BP), capillary glucose and weight via Bluetooth devices and mobile applications, followed by algorithm-based telecare by the investigators. They were assessed using the Self-Care Inventory Scale (SCIR) and medication adherence (Medication Adherence Report Scale 5) at baseline, 6-month and 24-month time-points. The data from 146 (intervention) and 152 (control) patients, with comparable baseline demographic profiles were eventually analysed. The decrease in HbA1c over 24 months was comparable between intervention and control group. Those in the intervention group were more likely to maintain their glycemic control (HbA1c ≤ 8%) (adjusted odds ratio (AOR) = 1.9, 95%confidence interval (CI) = 1.1-3.2; p = 0.028), had higher SCIR score (p = 0.004), and less likely to "never forget" (p = 0.022), or "stop medications" (p = 0.048), at 24-month time-point as compared to subjects in the control group. The glycaemic control of patients with T2DM continued to be maintained for another 18 months after 6 months of HTM, which were attributed to sustained self-care behaviour and medication adherence.

Potentially inappropriate prescription of medications to older adults who access a community pharmacy in Peru

Polypharmacy in older adults is associated with a higher incidence of medication-related problems, such as pharmacological interactions, adverse reactions, and medication errors. This study aimed to identify and evaluate potentially inappropriate prescription of medications (PIP) using the screening tool of older persons’ prescriptions/screening tool to alert doctors to right treatment (STOPP/START) criteria in a representative community pharmacy in Trujillo, Peru. The population sample consisted of 158 subjects, with 66.5% between 65 and 69 years old, 53.8% male, and 77.9% receiving between 3 and 4 medications. Medical prescriptions were analyzed using the explicit STOPP/START version 2 criteria, revealing that 93.7% of patients presented STOPP criteria (to stop medication) and 53.8% presented START criteria (to start medication). The most frequently identified STOPP criterion was the gradual withdrawal of benzodiazepines, while the most frequently identified START criterion was the initiation of antihypertensive treatment in patients with systolic blood pressure &amp;gt; 160 mmHg and diastolic blood pressure &amp;gt; 90 mmHg. Principal component analysis showed that the high prevalence of PIP was significantly associated (p &amp;lt; 0.05) with the number of prescribed medications and as age decreases, the number of medical diagnoses also decreases. It is concluded that there is a high prevalence of PIP in the studied population, posing a greater challenge in older adults, highlighting the importance of addressing prescribing practices with greater involvement of community pharmacists.

Use of the Patient Portal to Discuss Medications Among People with Dementia and Their Care Partners.

People with dementia (PWD) often use potentially inappropriate medications (PIM), exposing them to harm. Patient portals are a promising platform for delivering deprescribing educational interventions to reduce PIM use, yet little is known about how PWD and their care partners use patient portals to communicate with clinicians about medications. To characterize the content of patient portal messages relating to medications among PWD, care partners, and clinicians, to inform development of a portal-based intervention to reduce use of PIM among PWD. Descriptive analysis of data from the electronic health record and qualitative analysis of patient portal messages. Adults 65 and older, categorized as having dementia based on EHR algorithm, who received care in an academic health system from 2017 to 2022. Electronic health record data were analyzed using descriptive statistics. Qualitative coding identified topics raised in portal messages. A total of 399 message threads from 159 unique patients were analyzed. Patients were on average 78.4 years old (SD 8.0). Most (65%) were female, White (76%), and non-Hispanic/Latinx (96%); 15% had a registered proxy portal user. The most common topics raised in portal messages were logistics (42%), concerns about adverse effects/treatment burden (25%), asking for new medications (23%), and openness to stopping medications (21%). Qualitative analysis revealed three main themes related to deprescribing: (1) Opportunities to deprescribe, (2) challenges to deprescribing, and (3) medication-related counseling in the portal. PWD and their care partners frequently raise medication concerns in the portal, suggesting it is a promising platform for delivering deprescribing interventions for this population. Future research should identify characteristics of portal-based interventions that would best support deprescribing for PWD and develop pragmatic workflows.

Polypharmacy in an Older Female: Thoughtful Deprescribing

Abstract The magnitude of polypharmacy is on the rise as the global population faces a demographic shift with a larger proportion of older people, along with a marked increase in the prevalence of multimorbidity. An 85-year-old woman with diabetes mellitus, systemic hypertension, rheumatoid arthritis, chronic depression, parkinsonism, and dementia presented with inappropriate polypharmacy, taking 32 medications. Comprehensive medication reconciliation was performed using the Discuss, Review, Use tools, Geriatric medicine approach, and Stop medication guide, assessing appropriateness based on Beers Criteria. Goals of care were established through shared decision-making, focusing on reducing her pill burden and relaxing treatment targets for blood pressure and glycated hemoglobin. The patient was ultimately prescribed 13 medications. This case highlights the importance of tailored, patient-centered approaches in managing polypharmacy and chronic conditions in older adults to improve overall health outcomes.

“Starting to think that way from the start”: approaching deprescribing decision-making for people accessing palliative care - a qualitative exploration of healthcare professionals views

BackgroundDeprescribing has been defined as the planned process of reducing or stopping medications that may no longer be beneficial or are causing harm, with the goal of reducing medication burden while improving patient quality of life. At present, little is known about the specific challenges of decision-making to support deprescribing for patients who are accessing palliative care. By exploring the perspectives of healthcare professionals, this qualitative study aimed to address this gap, and explore the challenges of, and potential solutions to, making decisions about deprescribing in a palliative care context.MethodsSemi-structured interviews were conducted with healthcare professionals in-person or via video call, between August 2022 – January 2023. Perspectives on approaches to deprescribing in palliative care; when and how they might deprescribe; and the role of carers and family members within this process were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the NHS Health Research Authority (ref 305394).ResultsTwenty healthcare professionals were interviewed, including: medical consultants, nurses, specialist pharmacists, and general practitioners (GPs). Participants described the importance of deprescribing decision-making, and that it should be a considered, proactive, and planned process. Three themes were developed from the data, which centred on: (1) professional attitudes, competency and responsibility towards deprescribing; (2) changing the culture of deprescribing; and (3) involving the patient and family/caregivers in deprescribing decision-making.ConclusionsThis study sought to explore the perspectives of healthcare professionals with responsibility for making deprescribing decisions with people accessing palliative care services. A range of healthcare professionals identified the importance of supporting decision-making in deprescribing, so it becomes a proactive process within a patient’s care journey, rather than a reactive consequence. Future work should explore how healthcare professionals, patients and their family can be supported in the shared decision-making processes of deprescribing.Trial registrationEthical approval was obtained from the NHS Health Research Authority (ref 305394).

Prevalence and causes of medication transcription errors among hospitalized patients: An observational study and survey of nurses at a faith-based hospital in Cameroon

Medication errors are a leading cause of death globally; with the burden on resource-limited countries more than double that in high-income countries. Errors can occur at all stages of the medication use process; however, there is limited information on medication transcription errors (MTEs) among hospitalized patients in Africa. This study sought to determine the prevalence and types of MTEs and to assess nurses&amp;rsquo; perceptions of the likely causes of MTEs within the pediatric and general wards at a faith-based hospital in Cameroon. A prospective chart review of medication orders transcribed for patients admitted from April 1 to April 30, 2021, was conducted. Data analyzed included patient demographics, prevalence and types of MTEs, medication classes involved in MTEs, and nurse&amp;rsquo;s perceptions of the causes of MTEs. A total of 578 medication orders were reviewed for 75 patients, of whom 40 (53%) were female, and 30 were admitted to the pediatric ward. The results revealed that 38 MTEs were recorded, with 47% occurring on the medication administration sheet and dispensing cards. The most frequent MTEs were the omission of new and stop medication orders, involved in 28.9% and 26% of all MTEs, respectively. Antibacterials for systemic use were involved in the majority (55.3%) of MTEs. Illegible prescriptions (90.7%), distractions (87.0%), and high workload (77.8%) were ascribed as the most likely causes of MTEs. In conclusion, MTEs are common and pose a potential risk of patient harm in hospitalized patients. The adoption of a computerized provider order entry system could eliminate illegible prescriptions, reduce transcription processes, and alleviate workload, thereby improving patient safety.

Clinical Thoughts and Cases of Jianpi Yishen Sechang Decoction Combined with Acupuncture in the Treatment of Functional Diarrhea

Functional diarrhea (FDr) accounts for a relatively high proportion of digestive diseases. It is an infection that is not accompanied by abdominal pain and shows negative results in laboratory tests for bacteria and viruses. The main symptoms are persistent or recurrent discharge of watery and soft stools. The course of the disease is prolonged and recurring, and the treatment cost is higher and greatly affects the patient’s daily life. The incidence rate has a gradual increase in the trend. Its pathogenesis is complex where Western medicine is mostly used in symptomatic drug treatment. The treatment can be fast-acting and effective in relieving diarrhea. However, the long-term use of Western medicine poses a high risk in terms of side effects and a high chance of recurring upon stopping medication. At the same time, some diarrhea patients show the existence of drug-resistant strains of bacteria, and the overall efficacy of the drug is limited. Chinese medicine is mild and able to provide excellent treatment of diarrhea. With its lower price and cost, most families can afford it. Fengliang Tian, director of traditional Chinese medicine, implemented the “needle and medicine” method, which combines medicine and acupuncture, involving the usage of Jianpi Yishen Sechang Decoction and acupuncture in the treatment of functional diarrhea. The method has a low price, fewer side effects, is easy to accept, and can significantly reduce the recurrence rate with high efficacy. The study would like to share the clinical thinking and cases as follows to provide ideas and methods for the treatment of functional diarrhea by traditional Chinese medicine.

Perioperative antithrombotic medication: An approach for the primary care clinician.

The primary care clinician faces many challenges and is often left to manage complex pathology because of resource constraints at higher levels of care. One of these complex conditions is the perioperative management of antithrombotic medication. This narrative review is focused on helping the clinician navigate the complex path and multiple guidelines related to the perioperative use of antithrombotic medication. Perioperative antithrombotic guidelines (American College of Chest Physicians, European Society of Regional Anaesthesia, and American Society of Regional Anesthesia) and relevant publications were identified by a PubMed search using the terms perioperative AND anticoagulants OR antithrombotics AND guideline. Issues relevant to clinical practice were identified, and attempts were made to explain any ambiguity that arose. Adhering to basic pharmacological principles and evidence-based guidelines allows for the safe usage of antithrombotics. Knowing when to stop, continue, bridge and restart antithrombotic medication prevents perioperative morbidity and mortality. Stopping antithrombotic medication too early can lead to thromboembolic complications associated with their primary disease process. Not stopping antithrombotic medication or stopping it too late can potentially cause life-threatening bleeding, haematomas and increased transfusion requirements.

Prevalence and Associated Factors of Uncontrolled Hypertension Among Patients Attending Primary Healthcare Centers in Riyadh, Saudi Arabia.

Background Hypertension (HTN) is a global health issue as it causes significant mortality and morbidity among the worldwide population. Various treatments are available, but many patients are unable to control the disease. There are various factors like medication non-adherence and lifestyle habits that contribute to this problem. There is a need for evidence-based interventions to address HTN effectively, especially in regions like Saudi Arabia, where there is limited data on uncontrolled HTN. This study aimed to assess the prevalence of uncontrolled HTN and contributing factors to poor blood pressure control among patients in Primary Health Centers (PHCs) in Riyadh, Saudi Arabia. Methodology An analytical cross-sectional study was conducted using an interviewer-administered questionnaire among all patients aged 18 years and above who have uncontrolled HTN and who visited the PHCsof Riyadh's first health cluster in Saudi Arabia. Data was cleaned in Microsoft Excel and analyzed using IBM SPSS 29. Results The study comprised 516 patients with HTN. The majority were males (53.1%, n=274) compared to females (46.9%, n=242), with an average age of 58 years (SD=10.5). Notably, most patients were obese (63.2%, n=326), and 62.4% (n=322) had uncontrolled HTN. Multivariate analysis identified sociodemographic factors like higher education (p-value = 0.013, adjusted odds ratio (AOR) = 0.795) as protective against uncontrolled HTN, while employment (p-value = 0.031, AOR = 1.786) increased the risk of uncontrolled HTN. Risk factors such as smoking (p-value = 0.001, AOR = 3.011) and salt restriction (p-value = 0.021, AOR = 0.643) significantly influenced HTN control. Management-related predictors like stopping medication after feeling better (p-value = 0.001, AOR = 3.196) were also found significant. Conclusion This study revealed a high prevalence of uncontrolled HTN, especially among males and obese individuals. Sociodemographic factors like higher education were protective, while employment increased the risk of the disease. Further, smoking, salt restriction, and medication adherence significantly impacted HTN control, highlighting the importance of tailored interventions.

Exploring the role of the pharmacist within the Hospital@Home team at a tertiary centre in England

Abstract Introduction Hospital@Home (H@H) is an emerging healthcare model providing hospital-level care within patients’ homes (1). Despite its global presence for three decades, H@H adoption remains limited in the United Kingdom. The COVID-19 pandemic prompted National Health Service (NHS) England to promote virtual wards, including H@H, as an innovative care alternative (2). Among the pivotal functions in H@H are prescribing, administering, or stopping medications, where pharmacists play a critical role, undertaking these tasks along with the multidisciplinary team (MDT). However, there has been little research that investigates pharmacists’ scope of practice in H@H. Aim To explore the role of the pharmacist within the H@H team at a tertiary centre in England. Methods A qualitive study was conducted using 1) online (via Microsoft Teams) or in-person audio-recorded semi-structured interviews with pharmacists working in the tertiary centre’s H@H team, and 2) non-participant observations of purposively sampled MDT H@H team meetings; heart failure, general care and antibiotic. Pharmacists’ collaboration with MDT members, tasks they performed and how the MDT made decisions were the focus of the observations. Interview transcripts and observation field notes were concurrently analysed inductively to generate key themes. All three H@H pharmacists were approached to take part in the study. All members of the respective MDTs were recruited to take part in the observations. All participants gave informed consent. Results All three H@H pharmacists participated in interviews. Six MDT meetings were observed, attended by doctors (n=7), nurses (n=8) and pharmacists (n=3). Interviews lasted approximately 45 minutes each and MDT meetings lasted 30-120 minutes. Four main themes were generated from the analysis: 1. Scope of practice extends beyond a “traditional” pharmacist. 2. Being open-minded to a changing scope of practice. 3. Active collaboration with MDT members underpins and expands role. 4. Is intentional about, and advocates for the provision of patient-centered care. Pharmacists’ varied scope of practice (e.g. participating/co-leading MDT meetings and conducting home visits) placed them in pivotal roles in patient care coordination, treatment planning, and decision-making. Pharmacists were open-minded and proactive in expanding the scope of H@H care, and their role. They continuously acquired new skills as they encounter and provide diverse care scenarios. Their specialised knowledge and skillsets were viewed by the MDT as an asset. Pharmacists were reflective practitioners, saw patients as complex individuals with specific needs to care for and advocated for their needs. Conclusion To our knowledge, this is the first study exploring the role of the H@H pharmacist in England, adding to the knowledge base in this emerging service delivery; pharmacists undertake non-traditional clinical roles in the team, work collaboratively with others to expand the service and their own skillset, to advocate for the need of patients. Although only three pharmacists were interviewed, this was the entire available sample. The study did not include home visit observations, which could provide insights into pharmacists’ interactions with patients in their homes. Future research can focus on complementing the findings of this study with in-depth exploration of the pharmacist’s role in H@H settings.

Non‐pharmacological interventions in ID patients with challenging behaviours

The STOMP (stopping over‐medication of people with a learning disability, autism or both with psychotropic medicines) initiative and NICE guidelines regarding the management of challenging behaviour in adults with intellectual disability (ID) promote the use of non‐pharmacological approaches ahead of medication, with an emphasis also on reducing dosage or stopping medication where appropriate. Here the authors report on the findings of a service evaluation looking at how often a community intellectual disability psychiatry clinic initiates non‐pharmacological approaches in cases referred for challenging behaviour, and importantly whether this impacts the dosages of medication subsequently prescribed.

Tirzepatide-Induced Ketoacidosis in Non-Diabetic Patients.

Tirzepatide is a novel glucagon-like peptide 1/glucose-dependent insulinotropic peptide (GLP-1/GIP) receptor agonist. It was recently approved for diabetes control and weight reduction in non-diabetic patients. We report the first case of ketoacidosis after the use of tirzepatide in an obese non-diabetic patient, secondary to the possibility of starvation ketoacidosis and insulin resistance. The dual-acting GLP-1 and GIP receptor agonists, tirzepatide, can induce ketoacidosis in obese non-diabetic patients. The dual-acting GLP-1 and GIP receptor agonists can cause ketoacidosis in obese non-diabetic patients.Ketoacidosis induced by tirzepatide is serious, and physicians should be aware of this complication and be alert to early symptoms, check serum and urine ketone levels, and stop medication.

2007 Willingness of older adults and their informal caregivers to deprescribe medication: UK survey study

Abstract Introduction Reducing inappropriate polypharmacy is a major public health goal and deprescribing is considered one potential solution. Although patient attitudes towards deprescribing have been well studied, little consideration has been given to the informal caregiver perspective, how this differs from the views of patients and how that might influence care. Method A survey including demographic questions and the revised Patients’ Attitude Towards Deprescribing (rPATD) questionnaire was undertaken. The primary outcome was to identify the willingness of respondents to deprescribe. This survey was distributed as online, telephone or paper versions, via social media, community centres, day care centres, local organisations, and personal networks. It had two sections composed of equivalent questions: one for the ‘patient’ (age 65+, based in England, taking 1 prescription medication) and one for their ‘informal caregiver’ (age 18+). Data were analysed using descriptive statistics and binomial logistic regression. Results After exclusion of ineligible respondents, a total of 1,307 survey responses were received (861 patients and 446 caregivers). The average patient was 76±9 years, female (526; 61.6%), white (831; 97%), and educated to degree level (482; 56.9%). The average informal caregiver was 73±14 years, female (278; 62.9%), white (426; 96.4%) and educated to degree level (258; 58.2%). A total of 77.1% patients agreed that they were willing to deprescribe medications if their doctor said it was possible. In contrast, significantly fewer informal caregivers were happy for their patient to have medications deprescribed (59.7%; p-value for difference &amp;lt;0.001). Trust in physician, concerns about stopping medication and belief in the appropriateness of withdrawal were all associated with respondent willingness to deprescribe. Conclusion This large study suggests patients are more willing to deprescribe than their informal caregivers. Better understanding of these attitudes and how they differ between patients and informal caregivers, will help inform interventions to improve involvement in medication-related decisions.

Optimizing Medication and Patient Health through Deprescribing Practices

In this rapidly changing healthcare environment, optimizing medication regimens has become crucial for patient safety. This importance is emphasized by the increasing prevalence of polypharmacy - the use of multiple medications - which pose significant risk, especially in older adults, for adverse drug reactions, increased use of potentially inappropriate medications (PIMs), drug-drug interactions, and other factors that may threaten patient safety. In response to these challenges, deprescribing has gained prominence as an approach to enhance patient outcomes. More than simply stopping medications, deprescribing is a systematic process that aims to identify and discontinue specific drugs when their harm outweighs the benefit. This paper discusses the implications of polypharmacy, evaluates deprescribing tools and guidelines, assesses the barriers to implementing deprescribing practices, examines the roles of pharmacists, physicians and patients in deprescribing plans, and considers future trends and research directions to fill some of the gaps found within the actions of deprescribing. By providing this overview, this paper aims to start dialogue on how medication optimization can be used to improve patient health.

Prevalence of prescription drug abuse among patients with chronic pain attending in a pain clinic of a tertiary hospital

Background: Chronic pain and prescription drug abuse are extremely prevalent worldwide. Non-medical use of prescription drugs like opioids, central nervous system depressants and stimulants can lead to addiction, abuse or misuse, and diversion. It is not known what proportion of patients have already been exposed to prescription drug abuse presenting for chronic pain management. The main objective of the study was to assess the prevalence of prescription drug abuse among the patients presenting for chronic pain management.Method: The study was conducted at the out patient’s settings in the Pain Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka. Study population included patients suffering from chronic pain of at least 2 years duration and patients over 18 years of age. Both quantitative and qualitative methods of investigation were followed. The quantitative data was collected by face-to-face interview, clinical evaluation and recording of reports. Based on the patient information recorded 30 patients ( one-tenth of quantitative sample) were selected to find out the qualitative details through in-depth investigation of extent, trends, patterns and consequences of prescription drug abuse or misuse characteristics.Results: Quantitative data was collected from 305 patients. The average age of patients was 39.92 ± 9.61 years and male to female ratio was 2.2:1. Most of the patients were living in rural area 195 (64%). Chronic musculoskeletal pain was more prevalent among chronic pain patients 31% [95% CI: (26-36)]. The mean (±SD) duration of pain was 6.82 ± 3.45 years. Most commonly prescribed medications were NSAID 81% [95% CI: (76-85)], muscle relaxants 50% [95% CI: (45-56)] and opioids 41% [95% CI: (35-46)]. The prevalence of drug abuse was 64% [95% CI: (59-70)]. The specified ways of drug abuse revealed that 49% [95% CI: (42-56)] patients used medication without legal prescriptions, 21% [95% CI: (16-27)] used more than the prescribed dose and 30% [95% CI: (23-36)] used more than the prescribed duration for relieving pain. NSAID was the most common drug taken without legal prescription 72% [95% CI: (63-81)] and used more than the prescribed dose 57% [95% CI: (42-72)]. The most common cause of taking drugs more than prescribed dose and duration were initially relief of pain but gradually higher dose needed 79% [95% CI: (66-91)] and painful condition worsened after stopping medication 76% [95% CI: (65-87)], respectively. The common problems/complicationsrelated to drug abuse were mental disturbance 78 (26%), sleeplessness 69 (23%) and loss of memory 64 (21%).Conclusion: The prevalence of prescription drug abuse is high among chronic pain patients. Many patients suffer from abuse-related complications, which is a major concern for the healthcare system.