Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective, and interventions to support a proactive approach.

IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Petra Denig, Peter J C Stuijt
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引用次数: 0

Abstract

Introduction: For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering and/or lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, deprescribing rates of these so-called cardiometabolic medications are low. A review of challenges and interventions addressing these challenges in this population is pertinent.

Areas covered: We first provide an overview of relevant deprescribing recommendations. Next, we review challenges for healthcare providers (HCPs) to deprescribe cardiometabolic medication and provide insight in the patient and caregiver perspective on deprescribing. We summarize findings from research on implementing deprescribing of cardiometabolic medication and reflect on strategies to enhance deprescribing. We have used a combination of methods to search for relevant articles.

Expert opinion: There is a need for rigorous development and evaluation of intervention strategies aimed at proactive deprescribing of cardiometabolic medication. To address challenges at different levels, these should be multifaceted interventions. All stakeholders must become aware of the relevance of deintensifying medication in this population. Education and training for HCPs and patients should support patient-centered communication and shared decision-making. Development of procedures and tools to select eligible patients and conduct targeted medication reviews are important for implementation of deprescribing in routine care.

对患有 2 型糖尿病和/或心血管疾病的老年人取消处方的看法:从医疗服务提供者、患者和护理者的角度看所面临的挑战,以及支持积极主动方法的干预措施。
导言:对于 2 型糖尿病和/或心血管疾病患者来说,当他们年龄增长、健康状况恶化时,建议他们停用降糖、降压和/或降脂药物。迄今为止,这些所谓的心血管代谢药物的停药率很低。对这一人群所面临的挑战和应对这些挑战的干预措施进行回顾很有意义:我们首先概述了相关的取消处方建议。接下来,我们回顾了医疗服务提供者(HCPs)在开具心脏代谢药物处方时所面临的挑战,并从患者和护理人员的角度深入分析了开具处方的问题。我们总结了有关实施心脏代谢药物去处方化的研究结果,并思考了加强去处方化的策略。我们采用了多种方法搜索相关文章:专家观点:有必要严格制定和评估旨在主动取消心脏代谢药物处方的干预策略。为了应对不同层面的挑战,这些干预措施应该是多方面的。所有利益相关者都必须认识到对这一人群减量用药的意义。针对保健医生和患者的教育和培训应支持以患者为中心的沟通和共同决策。开发相关程序和工具以选择符合条件的患者并进行有针对性的药物审查,对于在常规护理中实施减量用药非常重要。
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来源期刊
Expert Review of Clinical Pharmacology
Expert Review of Clinical Pharmacology PHARMACOLOGY & PHARMACY-
CiteScore
7.30
自引率
2.30%
发文量
127
期刊介绍: Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery. Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.
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