4CPS-179 The wide review of polypharmacy in the frail older person
Notice bibliographique
Résumé
<h3>Background and importance</h3> The WIDE (Wholistic Integrated Deprescribing Evaluation) review is an innovative model of patient-led, pharmacist facilitated medication review. It involves establishing patients‘ priorities and experiences of their medicines, collaborating with primary care providers and evaluating if medicines should be deprescribed because their potential harms outweigh their potential benefits. Frailty is synonymous with vulnerability, including to medication harms. To assess the potential for harm, the WIDE review model incorporates the STOPP/START criteria and the medication appropriateness index (MAI) tools, the use of which have demonstrated improvements in patient outcomes. However, the impact of a patient-led deprescribing model has not yet been studied in this setting. <h3>Aim and objectives</h3> To examine the impact and cost effectiveness of WIDE reviews. <h3>Material and methods</h3> This quantitative prospective cohort study was conducted over 8 weeks. <h3>Inclusion criteria</h3> inpatients aged >65 years and prescribed >5 regular medications who screened positive for frailty (PRISMA 7 score >3). Critically ill patients were excluded. Eligible patients were randomly allocated to the intervention or control group. Regular medications were enumerated and screened using the STOPP/START criteria on admission and discharge. The intervention group received a WIDE review and their MAI score was calculated on admission and discharge. In conjunction with the patients and their consultants, deprescribing plans were devised and communicated to their GPs and community pharmacists. <h3>Results</h3> A total of 20 intervention and 20 control group patients were enrolled. Patient characteristics (age, sex and length of stay) were similar for both groups. A total of 65% of STOPP and 62% of START criteria were addressed in the intervention group versus 12% and 5%, respectively, in the control group. In the intervention group, 83 medications were stopped, 23 doses were reduced and the total MAI score was reduced by 64%. Cost savings to the annual drug budget alone represented a 9:1 return on investment of hospital pharmacist time. Most discontinuations and dose reductions were sustained (98%) and 92% of future recommendations were enacted on 6 months of follow-up. <h3>Conclusion and relevance</h3> Pharmacists performing patient-led WIDE reviews significantly improved medication appropriateness and realised compelling cost savings. A large scale, multi-site study is warranted to demonstrate the reproducibility of these results. <h3>References and/or acknowledgements</h3> No conflict of interest.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».