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Published on: July 24, 2013
Evaluation of deprescribing services in frail patients: a systematic review
Dalal Alshatti1, Anthony R Cox2, Christine Hirsch3
1Clinical Pharmacy, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, 3rd floor, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Background:
Deprescribing, a process of dose reduction or withdrawal of inappropriate medication that no longer has benefit, is a proposed intervention in the care of older adults living with frailty.
Objective/Aim:
To evaluate the safety, effectiveness, and clinical impact of deprescribing services in frail patients.
Methods:
A systematic literature search was performed in November 2023 using Scopus, CINAHL PLUS (EBSCO), MEDLINE (OVID and EMBASE), and Cochrane Library. The Mixed Methods Appraisal tool was used for appraising the methodological quality of the included papers. Studies were selected after title, abstract, and full-text screening, with independent review. Thematic analysis was used for analysing data from the selected articles.
Results:
Five hundred ninety unique titles were identified, with nine (six trials, one interview, one survey, and one designed-delay study) meeting inclusion and exclusion criteria. Four main descriptive themes have been identified: challenges of deprescribing in frailty, facilitators of deprescribing in frailty, deprescribing processes in current practice in frail patients, and deprescribing outcomes. Additionally, two analytical themes have been identified: safety and quality.
Conclusion:
A number of issues have been highlighted that impact the implementation of deprescribing services in frail patients. Currently, there is limited evidence showing strong benefits of such deprescribing services, such as reducing the number of potentially inappropriate medications and medication costs.
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