Boland, Paul

Clegg, Andrew

Doherty, Alison Jayne

Hedgecoe, Lynn

Reed, Janet

Ruaraidh, Hill

Shaw, Beth

Stephani, Anne-Marie

Walker, Lauren

Williams, Nefyn

English

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BACKGROUND: • Polypharmacy within adults with multimorbidities is a significant challenge for global healthcare systems (1).• Previous reviews have not fully explored the different cultural, organisational, interpersonal and individual-level barriersand facilitators to safe deprescribing in patients with multimorbidities and polypharmacy in primary care (2).• Using a socio-ecological approach, this review aimed to identify the barriers and facilitators to safe deprescribing for adultswith multimorbidities and polypharmacy in primary care settings.• This work is linked to UN Sustainability Development Goal 3 ‘Good health and well-being’, Target 3.8 – ‘Achieve universalhealth coverage, including financial risk protection, access to quality essential health-care services and access to safe,effective, quality and affordable essential medicines and vaccines for all’.METHODS:A systematic review of studies published in 2000 - 2019 examining barriers and facilitators to safe deprescribing interventions for patients with multimorbidities and polypharmacy.RESULTS:40 studies from 14 different countries were included in the review.  The review found complex cultural, organisational, interpersonal and individual level barriers to deprescribing in patients with multimorbidities and polypharmacy in primary care,and suggested facilitators to address these:Barriers and facilitators to deprescribing in primary care for patients with multimorbidities and polypharmacy: a systematic reviewAUTHORS: Doherty, A.J.*, Boland, P.*, Reed, J.*, Clegg, A.J*, Stephani, A-M.*,Williams, N.H, Hedgecoe, L.*, Hanson, E.*, Shaw, B., Hill, R., and Walker, L.Whole-systems based changes are needed for safe deprescribing in patients with multimorbidities and polypharmacy.This report is independent research funded by the National Institute for Health Research Applied Research Collaboration North West Coast (ARC NWC). The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. * These authors are part-funded by NIHR ARC NWCProduced by the Health Technology Group, UCLan / NIHR ARC NWC MIDAS ThemeREFERENCES:(1) World Health Organisation. Medication Without Harm – Global Patient Safety Challenge on Medication Safety. 2017. [Available from: https://apps.who.int/iris/bitstream/handle/10665/255263/WHO-HIS-SDS-2017.6-eng.pdf] Accessed 04.12.19.(2) Sinnott C, McHugh S, Browne J, et al., GPs' perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open. 2013;3:e003610.CONCLUSIONA whole systems patient-centred approach to safe deprescribing interventions is required, involving key decision-makers, healthcare professionals, patients and carers.ORGANISATIONALINTERPERSONAL• Prescribing culture – diagnosis and prescribing new medications  • Lack of non-pharmaceutical alternatives• Single disease focused evidence-base and guidance• Lack of guidance on interactions of different medications• Insufficient tools and resources• Fragmented care • Prescriber uncertainties • Reluctance to cease medication started by another specialist.• Fears about the adverse affects of stopping a medication • Patient may not want to cease long-term medications• Patients put trust in their doctor and may have attitude of  “doctor knows best”• Patient may have cognitive impairment and be reliant on the support of others• A prudent prescribing culture• Better evidence-based multimorbidities guidance • Improved communication between patient, doctor and other health and social care providers• Continuity of care• Closer collaboration between pharmacists, GPs and other interdisciplinary services• Improved prescriber and patient awareness, understanding and knowledge• Patient centred care and patient involvement in decision-making• Patient wanting to take fewer medicationsBARRIERS FACILITATORSCULTURALINDIVIDUAL

Barriers and facilitators to deprescribing in primary care for patients with multimorbidities and polypharmacy: a systematic review

http://clok.uclan.ac.uk/34635/1/polypharmacy%20poster%20Health%20%26%20Wellbeing%20.pdf

Barriers and facilitators to deprescribing in primary care for patients with multimorbidities and polypharmacy: a systematic review

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