What do clinical practice guidelines say about deprescribing? A scoping review.

IF 5.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

BMJ Quality & Safety Pub Date : 2024-05-24 DOI:10.1136/bmjqs-2024-017101

Aili Veronica Langford, Imaan Warriach, Aisling M McEvoy, Elisa Karaim, Shyleen Chand, Justin P Turner, Wade Thompson, Barbara J Farrell, Danielle Pollock, Frank Moriarty, Danijela Gnjidic, Nagham J Ailabouni, Emily Reeve

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引用次数: 0

Abstract

Introduction: Deprescribing (medication dose reduction or cessation) is an integral component of appropriate prescribing. The extent to which deprescribing recommendations are included in clinical practice guidelines is unclear. This scoping review aimed to identify guidelines that contain deprescribing recommendations, qualitatively explore the content and format of deprescribing recommendations and estimate the proportion of guidelines that contain deprescribing recommendations.

Methods: Bibliographic databases and Google were searched for guidelines published in English from January 2012 to November 2022. Guideline registries were searched from January 2017 to February 2023. Two reviewers independently screened records from databases and Google for guidelines containing one or more deprescribing recommendations. A 10% sample of the guideline registries was screened to identify eligible guidelines and estimate the proportion of guidelines containing a deprescribing recommendation. Guideline and recommendation characteristics were extracted and language features of deprescribing recommendations including content, form, complexity and readability were examined using a conventional content analysis and the SHeLL Health Literacy Editor tool.

Results: 80 guidelines containing 316 deprescribing recommendations were included. Deprescribing recommendations had substantial variability in their format and terminology. Most guidelines contained recommendations regarding for who (75%, n=60), what (99%, n=89) and when or why (91%, n=73) to deprescribe, however, fewer guidelines (58%, n=46) contained detailed guidance on how to deprescribe. Approximately 29% of guidelines identified from the registries sample (n=14/49) contained one or more deprescribing recommendations.

Conclusions: Deprescribing recommendations are increasingly being incorporated into guidelines, however, many guidelines do not contain clear and actionable recommendations on how to deprescribe which may limit effective implementation in clinical practice. A co-designed template or best practice guide, containing information on aspects of deprescribing recommendations that are essential or preferred by end-users should be developed and employed.

Trial registration number: osf.io/fbex4.

查看原文本刊更多论文

临床实践指南如何看待去处方化？范围审查。

介绍：减药（减少或停止用药剂量）是合理处方的一个组成部分。临床实践指南在多大程度上包含了去处方化建议尚不明确。本次范围审查旨在确定包含去处方化建议的指南，定性探讨去处方化建议的内容和形式，并估算包含去处方化建议的指南比例：方法：在文献数据库和谷歌中搜索了2012年1月至2022年11月期间出版的英文指南。搜索了 2017 年 1 月至 2023 年 2 月期间的指南注册信息。两名审稿人独立筛选数据库和谷歌中包含一项或多项去处方化建议的指南记录。从指南注册表中抽取10%的样本进行筛选，以确定符合条件的指南，并估算包含去处方化建议的指南比例。采用传统的内容分析法和SHeLL健康素养编辑工具，提取了指南和建议的特征，并检查了去处方化建议的语言特点，包括内容、形式、复杂性和可读性：结果：共纳入了 80 份指南，其中包含 316 项处方建议。去处方化建议的格式和术语存在很大差异。大多数指南都包含关于谁（75%，n=60）、什么（99%，n=89）以及何时或为什么（91%，n=73）去处方的建议，但包含如何去处方的详细指导的指南较少（58%，n=46）。在登记样本中发现，约 29% 的指南（n=14/49）包含一项或多项去处方化建议：去处方化建议正被越来越多地纳入指南中，然而，许多指南并不包含关于如何去处方的明确且可操作的建议，这可能会限制在临床实践中的有效实施。应开发并采用共同设计的模板或最佳实践指南，其中包含最终用户所必需或偏好的去处方化建议方面的信息。试验注册号：osf.io/fbex4。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-

CiteScore

9.80

自引率

7.40%

发文量

104

审稿时长

4-8 weeks

期刊介绍： BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.