Interventions to Address Potentially Inappropriate Prescribing for Older Primary Care Patients: A Systematic Review and Meta-Analysis.

Importance: Prescriptions for potentially inappropriate medications are common and, by definition, may carry risks that outweigh benefits.

Objective: To determine whether interventions to address potentially inappropriate prescribing for older primary care patients are associated with changes in the number of medications prescribed, drug-related harms, hospitalizations, and mortality.

Data Sources: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 6, 2024.

Electronic Decision Support for Deprescribing in Older Adults Living in Long-Term Care: A Stepped-Wedge Cluster Randomized Trial.

Importance: Potentially inappropriate prescribing (PIP) is common, costly, and harmful. Deprescribing potentially inappropriate medications (PIMs) is a priority for improving the health outcomes of older adults. PIP is especially common in long-term care homes, with up to 88% of residents affected.

Global Practice Variation in the Management of Infections: An International Cross-Sectional Survey of Clinicians.

Background: infections (CDIs) are associated with significant morbidity, mortality, and economic burden globally. International guidelines conflict on various aspects of management, so we conducted a clinician survey to evaluate global practice variability on CDI diagnosis, treatment, and prophylaxis to inform future clinical trials.

Methods: An anonymous online survey through REDCap was distributed through multiple channels.

Criteria to Report Adverse Drug Withdrawal Events in Clinical Trials: A Systematic Review.

Background: Polypharmacy is a major risk factor for adverse drug events (ADEs), which are a common cause of hospitalization, especially among older adults. Deprescribing is a promising strategy to prevent ADEs; however, clinicians may hesitate to deprescribe for fear of causing adverse drug withdrawal events (ADWEs). Collectively, ADWEs are the re-emergence of symptoms or a disease state due to the discontinuation of a medication.

Prescribing Patterns and Impact of Sedatives in Hospitalized Older Adults: A Secondary Analysis of the MedSafer Study.

Background: We aimed to examine the impact of sedative prescription patterns in hospitalized older adults on post-discharge adverse drug events (ADEs), falls, and sleep.

Methods: We conducted a secondary analysis of the MedSafer randomized controlled trial (RCT; NCT03272607) which included hospitalized adults ≥ 65 years of age who were taking ≥ 5 medications. We identified patients who completed follow-up at 30 days post-discharge and provided patient-reported outcomes for sleep disturbance (PROMIS SD 4a).

Evaluation of influenza antiviral prophylaxis for long-term care residents: a systematic review and meta-analysis.

Background: Influenza is a pervasive respiratory infection which disproportionately burdens long-term care residents. To limit outbreaks, guidelines recommend antiviral prophylaxis, particularly oseltamivir or zanamivir, despite acknowledging the inadequate supporting evidence. Therefore, we aimed to review the literature on the efficacy of oseltamivir, zanamivir, and baloxavir prophylaxis for influenza in long-term care.

Prevalence of medication overload among older people with HIV: a MedSafer study.

Background: Older people with HIV (PWH) are at risk of polypharmacy (taking multiple medications). Most medications may be necessary and indicated to manage HIV (e.g.

Efficacy of weekly versus daily cholecalciferol for repleting serum vitamin D (25(OH)D) deficiency: A systematic review and meta-analysis of randomized controlled trials.

Background/rationale: Weekly cholecalciferol can replace daily supplementation to reduce pill burden in patients with complex medication regimens and hypovitaminosis D, but evidence supporting this switch is unclear.

Objective: We aimed to determine whether weekly cholecalciferol was superior to daily cholecalciferol to replete patients with hypovitaminosis D.

Methods: We conducted a systematic review of randomized controlled trials involving participants with baseline hypovitaminosis D (<30 ng/ml) comparing weekly versus daily cholecalciferol dosing and where serum cholecalciferol was measured within 120 days of starting treatment.

The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study.

Background: Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.

Methods: This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society.

Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study.

Rationale & Objective: Patients treated with dialysis are commonly prescribed multiple medications (polypharmacy), including some potentially inappropriate medications (PIMs). PIMs are associated with an increased risk of medication harm (eg, falls, fractures, hospitalization). Deprescribing is a solution that proposes to stop, reduce, or switch medications to a safer alternative.

Electronic Decision Support for Deprescribing in Patients on Hemodialysis: Clinical Research Protocol for a Prospective, Controlled, Quality Improvement Study.

Background: Patients on dialysis are commonly prescribed multiple medications (polypharmacy), many of which are potentially inappropriate medications (PIMs). Potentially inappropriate medications are associated with an increased risk of falls, fractures, and hospitalization. MedSafer is an electronic tool that generates individualized, prioritized reports with deprescribing opportunities by cross-referencing patient health data and medications with guidelines for deprescribing.

Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza: A Systematic Review and Meta-Analysis.

Importance: Despite widespread use, summary evidence from prior meta-analyses has contradictory conclusions regarding whether oseltamivir decreases the risk of hospitalization when given to outpatients. Several large investigator-initiated randomized clinical trials have not yet been meta-analyzed.

Objective: To assess the efficacy and safety of oseltamivir in preventing hospitalization among influenza-infected adult and adolescent outpatients.

Diagnostic yield of CT head in delirium and altered mental status-A systematic review and meta-analysis.

Background: CT head is commonly performed in the setting of delirium and altered mental status (AMS), with variable yield. We aimed to evaluate the yield of CT head in hospitalized patients with delirium and/or AMS across a variety of clinical settings and identify factors associated with abnormal imaging.

Methods: We included studies in adult hospitalized patients, admitted to the emergency department (ED) and inpatient medical unit (grouped together) or the intensive care unit (ICU).

Drug Interactions With Nirmatrelvir-Ritonavir in Older Adults Using Multiple Medications.

This quality improvement study uses data from the MedSafer trial to evaluate drug-drug interactions between nirmatrelvir-ritonavir and maintenance medications to identify use of potentially inappropriate medications in older adults with polypharmacy.

MedSafer to Support Deprescribing for Residents of Long-Term Care: a Mixed-Methods Study.

Background: Polypharmacy is prevalent in long-term care homes (LTCH) and increases the risk of adverse drug events. Feasible and effective deprescribing interventions applicable in the LTCH environment are needed.

Methods: We performed a mixed methods study to evaluate the feasibility, applicability, and effectiveness of an electronic deprescribing tool, MedSafer, to facilitate quarterly medication reviews (QMRs) on two pilot units in an academic long-term care home (LTCH).

Deprescribing Opportunities for Hospitalized Patients With End-Stage Kidney Disease on Hemodialysis: A Secondary Analysis of the MedSafer Cluster Randomized Controlled Trial.

Background: End-stage kidney disease patients on dialysis have a substantial risk of polypharmacy due their propensity for comorbidity and contact with the health care system. MedSafer is an electronic decision support tool that integrates patient comorbidity and medication lists to generate personalized deprescribing reports focused on identifying potentially inappropriate medications (PIMs).

Objective: To conduct a secondary analysis of patients on regular hemodialysis included in the MedSafer randomized controlled trial to investigate the patterns of polypharmacy and evaluate the efficacy of the MedSafer deprescribing algorithms.

Fluvoxamine for Outpatient Management of COVID-19 to Prevent Hospitalization: A Systematic Review and Meta-analysis.

Importance: Widely available and affordable options for the outpatient management of COVID-19 are needed, particularly for therapies that prevent hospitalization.

Objective: To perform a meta-analysis of the available randomized clinical trial evidence for fluvoxamine in the outpatient management of COVID-19.

Data Sources: World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.

Inhaled corticosteroids for outpatients with COVID-19: a meta-analysis.

https://bit.ly/3B2sDUi

The MedSafer Study-Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial.

Importance: Scalable deprescribing interventions may reduce polypharmacy and the use of potentially inappropriate medications (PIMs); however, few studies have been large enough to evaluate the impact that deprescribing may have on adverse drug events (ADEs).

Objective: To evaluate the effect of an electronic deprescribing decision support tool on ADEs after hospital discharge among older adults with polypharmacy.

Design, Setting, And Participants: This was a cluster randomized clinical trial of older (≥65 years) hospitalized patients with an expected survival of more than 3 months who were admitted to 1 of 11 acute care hospitals in Canada from August 22, 2017, to January 13, 2020.

Spread and scale of an electronic deprescribing software to improve health outcomes of older adults living in nursing homes: study protocol for a stepped wedge cluster randomized trial.

Background: Medication overload or problematic polypharmacy is a major problem causing widespread harm, particularly to older adults. Taking multiple medications increases the risk of potentially inappropriate medications (PIMs), and residents in long-term care (LTC) are frequently prescribed 10 or more medications at once. One strategy to address this problem is for the physician and/or pharmacist to perform regular medication reviews; however, this process can be complicated and time-consuming.