title: What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: a modified delphi process.
abstract: Polypharmacy and inappropriate medication use among older adults contribute to adverse drug reactions, falls, cognitive impairment, noncompliance, hospitalization and mortality. While deprescribing - tapering, reducing or stopping a medication - is feasible and relatively safe, clinicians find it difficult to carry out. Deprescribing guidelines would facilitate this process. The aim of this paper is to identify and prioritize medication classes where evidence-based deprescribing guidelines would be of benefit to clinicians. A modified Delphi approach included a literature review to identify potentially inappropriate medications for the elderly, an expert panel to develop survey content and three survey rounds to seek consensus on priorities. Panel participants included three pharmacists, two family physicians and one social scientist. Sixty-five Canadian geriatrics experts (36 pharmacists, 19 physicians and 10 nurse practitioners) participated in the survey. Twenty-nine drugs/drug classes were included in the first survey with 14 reaching the required (≥ 70%) level of consensus, and 2 new drug classes added from qualitative comments. Fifty-three participants completed round two, and 47 participants completed round three. The final five priorities were benzodiazepines, atypical antipsychotics, statins, tricyclic antidepressants, and proton pump inhibitors; nine other drug classes were also identified as being in need of evidence-based deprescribing guidelines. The Delphi consensus process identified five priority drug classes for which expert clinicians felt guidance is needed for deprescribing. The classes of drugs that emerged strongly from the rankings dealt with mental health, cardiovascular, gastroenterological, and neurological conditions. The results suggest that deprescribing and overtreatment occurs through the full spectrum of primary care, and that evidence-based deprescribing guidelines are a priority in the care of the elderly.
authors: Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada; School of Pharmacy, University of Waterloo, Waterloo, Canada.
authors: Barbara
authors: B
authors: Farrell
authors: Bruyère Research Institute, Ottawa, Canada; School of Pharmacy, University of Waterloo, Waterloo, Canada.
authors: Corey
authors: C
authors: Tsang
authors: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
authors: Lalitha
authors: L
authors: Raman-Wilms
authors: Bruyère Research Institute, Ottawa, Canada.
authors: Hannah
authors: H
authors: Irving
authors: Bruyère Research Institute, Ottawa, Canada; Department of Applied Human Sciences, Concordia University, Montreal, Canada.
authors: James
authors: J
authors: Conklin
authors: Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada.
authors: Kevin
authors: K
authors: Pottie
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D003697:Delphi Technique; D000069340:Deprescriptions; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D055317:Evidence-Based Practice; D005260:Female; D005853:Geriatrics; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D011795:Surveys and Questionnaires