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Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons

Roxana De las Salas1★, Javier Eslava-Schmalbach2, Claudia Vaca-González1, Dolores Rodríguez3, Albert Figueras3★ Corresponding author

  1. 1Department of Pharmacy, Faculty of Sciences, National University of Colombia, Bogotá, Colombia.
  2. 2Department of Public Health, Faculty of Medicine, National University of Colombia, Bogotá, Colombia.
  3. 3Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Barcelona, Spain.

CORRESPONDENCE

Roxana De las Salas

Department of Pharmacy, Faculty of Sciences, National University of Colombia, Bogotá, Colombia.

rpdem@unal.edu.co

Received: 13-07-2020; Accepted: 22-11-2020.

Volume 18, Issue 4 · pp. 2033 · PUBLISHED 4 December 2020 · DOI: 10.18549/PharmPract.2020.4.2033

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ABSTRACT

Objective: The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons. Methods: We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity ratio, item-level content validity, and Fleiss' Kappa statistics was measured to establish reliability. The same voting method was used for round 2. Results: A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0.77 (95% CI 0.60-0.93), for domains with Kappa= 0.73 (95%CI 0.60-0.86) and for decisions with Kappa= 0.97 (95%CI 0.90-1.00). Conclusions: This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient's and caregiver's preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons' medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice.

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    Salas, R. D. L., Eslava-Schmalbach, J., Vaca-González, C., Rodríguez, D., & Figueras, A. (2020). Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons. Pharmacy Practice, 18(4), 2033. https://doi.org/10.18549/PharmPract.2020.4.2033