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Ontario Deprescribing Project Update - March 2015
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Ontario Deprescribing Project Update
March 2015

The evidence based Deprescribing guidelines aim to support interdisciplinary teams of healthcare professionals in tapering or stopping medications and monitoring for adverse drug withdrawal reactions in elderly patients. The project’s research team expects that this will reduce adverse drug effects, polypharmacy, and improve quality of life.

News

Proton Pump Inhibitor Deprescribing Guideline (Guideline #1)

Proton Pump Inhibitor (PPI): A class of medications/drugs that reduce acid production in your stomach. They are commonly used to treat heartburn, among other conditions.
  • Piloted from June to November 2014 in three Ottawa-area Long-Term Care Facilities and three Family Health Teams
  • Implementation facilitated by: incorporation into routine medication reviews, assistance of pharmacist to identify eligible patients for deprescribing and find original PPI indication
  • Implementation challenged by: multiple competing activities, large number of undocumented indications for PPI
  • Guideline development team is responding to reviewer comments and incorporating changes based on pilot experience

Benzodiazepine Deprescribing Guideline (Guideline #2)

Benzodiazepine receptor antagonists (BZRA): A class of medications/drugs also called “hypnotics” or “sedatives” that are commonly used for insomnia, among other conditions.
  • Guideline development team has finished its draft guideline and clinical review is ongoing
  • Implementation has started at 5 sites in the Ottawa area (three Long-Term Care and two Family Health Team) 

Antipsychotic Deprescribing Guideline (Guideline #3)

Antipsychotics (AP): A class of medications/drugs used to treat psychosis, often used in the treatment of schizophrenia, among other conditions.
  • Welcome to the Antipsychotic Deprescribing Guideline Development Team members:
    • Dr. Lise Bjerre, MD, PhD, C.T. Lamont Centre, Bruyère Research Institute & Department of Epidemiology and Community Medicine, University of Ottawa
      (Guideline Lead)
    • Dr. Barbara Farrell, PharmD, C.T. Lamont Centre, Bruyère Research Institute, Department of Family Medicine, University of Ottawa and School of Pharmacy, University of Waterloo
    • Dr. Andrew Wiens, MD, Royal Ottawa Mental Health Centre, Department of Family Medicine, University of Ottawa
    • Dr. Carlos Rojas-Fernandez, PharmD, School of Pharmacy, University of Waterloo
    • Dr. Genevieve Lemay, MD, The Ottawa Hospital
    • Dr. Lalitha Raman-Wilms, PharmD, Leslie Dan Faculty of Pharmacy, University of Toronto
    • Dr. Lisa McCarthy, PharmD, Leslie Dan Faculty of Pharmacy, University of Toronto
    • Dr. Lyla Graham, MD, St. Patrick's Home of Ottawa
    • Dr. Samir Sinha, MD, DPhil, Mount Sinai and the University Health Networks Hospitals
    • Dr. Vivian Welch, PhD, Bruyère Research Institute
  • The team met in Ottawa on Thursday, February 26th to establish the scope and parameters for development of the Antipsychotic Deprescribing Guideline (see picture below).
  • The guideline should be ready for clinical review by late spring and piloting by June.
L to R: (in person) Matt Hogel (guideline coordinator), Vivian Welch, Genevieve Lemay, Lalitha Raman-Wilms, Barbara Farrell, Lise Bjerre, Lyla Graham, and Andrew Wiens; (via Skype): Lisa McCarthy and Carlos Rojas-Fernandez

Spreading the Word

  • PLoS ONE: Barbara Farrell et al, What are priorities for deprescribing for elderly patients? Capturing the voices of practitioners: a modified Delphi process, article accepted! (in press)
  • Canadian Pharmacists Conference, Ottawa, ON, May 2015 (upcoming):
    • Presentation: Deprescribing guidelines for the elderly: how developmental evaluation is strengthening our process
    • Poster: Deprescribing guidelines for the elderly: preliminary outcomes of a developmental evaluation
  • North American Primary Care Research Group annual meeting, New York, NY, November 2014: Barbara Farrell: Deprescribing guidelines for the elderly: Preliminary Outcomes of a Developmental Evaluation (poster)
  • OPEN Summit, Toronto, ON, October 2014: attendees included other Ontario Pharmacy Research Collaboration investigators, staff, and stakeholder representatives (e.g. Ministry of Health and Long-Term Care, Ontario Pharmacists Association, Ontario College of Pharmacists, and Canadian Pharmacists Association)
    • Presentations:  Developing deprescribing capacity through developmental evaluation, Deprescribing guideline development: methods and results of a proton-pump inhibitor deprescribing guideline, What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: a modified Delphi process, Measuring self-efficacy for deprescribing tasks: Development of a scale and initial results. 
    • Posters:  Developing, implementing and evaluating ‘deprescribing’ guidelines for the elderly: a mixed methods approach, Evaluating the development of ‘deprescribing’ guidelines for the elderly: a qualitative approach, Deprescribing guidelines: Knowledge to action process 
  • Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, November 2014: Lalitha Raman-Wilms: Development, Implementation and Evaluation of Deprescribing Guidelines (presentation)
  • Ontario Long Term Care Physicians Annual Meeting "Long Term Care for Practicing Clinicians", Toronto, ON, November 2014: Barbara Farrell: Developing and using deprescribing guidelines: example PPI (presentation)
  • Canadian Society of Hospital Pharmacists 66th Annual General Meeting and Awards Ceremony, Toronto, ON, November 2014: Lalitha Raman-Wilms: Deprescribing guidelines (presentation)
  • Canadian Association on Gerontology “Landscapes of Aging” Annual Scientific and Educational Meeting, Niagara Falls, ON, October 2014: James Conklin: Using developmental evaluation to facilitate the creation and implementation of evidence-based deprescribing guidelines (presentation)
  • Regional Geriatric Program of Eastern Ontario Annual General Meeting, Ottawa, ON, October 2014: Barbara Farrell & James Conklin: Deprescribing guidelines for the elderly: Preliminary Outcomes of a Developmental Evaluation (presentation)
  • Ontario College of Pharmacists Regional CE Coordinators meeting, Toronto, ON, October 2014: Barbara Farrell: The why and how of deprescribing (presentation)
  • University of Ottawa Summer Studentship Poster Presentations, Ottawa, ON, October 2014: Lindsay Anderson: Evaluating the development of ‘deprescribing’ guidelines for the elderly: a qualitative approach (poster)
  • University of Toronto, Faculty of Pharmacy, Toronto, ON, October 2014: Lalitha Raman-Wilms, Barabara Farrell, & James Conklin: Introduction to Models and Methods of Research in Clinical, Social, and Administrative Pharmacy (guest lecture in PHM 1128)

Twitter Update

  • Deprescribing has Twitter followers all over the world!
source: Tweepsmap.com 
source: Tweepsmap.com
  • @Deprescribing has tweeted over 400 tweets! We tweet 0.71 tweets per day on average, and you are most likely to see tweets from us on a Wednesday at noon.
  • Below is a breakdown of the words we use the most:
source: Tweetstats.com

Spotlight on Deprescribing

Interesting Articles

National and International Progress

  • Dr. Farrell attended a Canadian national stakeholders’ meeting to reduce over-prescription of drugs to seniors, on Jan. 23, 2015 in Toronto.  Organized by Dr. Cara Tannenbaum, University of Montreal, this group is moving forward with a number of subcommittees to implement a national action plan – more to come…
  • Dr. James McCormack, University of British Columbia, is working on a website that will help people prioritize medications that can be stopped in frail, older patients: watch for Medstopper! 
  • Alzheimer Australia developed an education video for clinical staff in October 2014 on deprescribing antipsychotic medications in patients with dementia. The team is led by Dr. Henry Brodaty, Scientia Professor of Ageing and Mental Health, University of New South Wales. http://www.youtube.com/watch?v=LIIKE4NHXAQ
  • The Australian Deprescribing Network (ADeN) and its 25 members wrote an article detailing the process of deprescribing which has been accepted for publication in the Journal of the American Medical Association Internal Medicine. 
  • Amy Page presented her 3-minute-thesis Too much of a good thing? Deprescribing medications in older adults in October 2014 at the University of Western Australia. Watch the presentation here http://www.youtube.com/watch?v=iuEBT7cz1Xo

Fun Facts

  • In our last newsletter, we reported that the term ‘deprescribing’ generated approximately 8,000 results in Google search. We are now excited to say that number has doubled… deprescribing has over 16,000 results!

Deprescribing Team Update

  • Congratulations to Lisa Pizzola, Project Manager on her new position at Abbott Nutrition as Territory Manager. Lisa joined the Deprescribing project in November 2013. With her Masters of Science in Nutrition Research, Lisa’s new position opens exciting doors for her!
  • We welcomed Katherine Smith as our new Project Manager in November 2014. Katherine has a M.Sc. in Health and Rehabilitation Sciences from the University of Western Ontario and has experience working on pharmaceutical clinical trials and in clinical research.
  • Welcome to our latest students, residents and staff:
    • Andy Ma, pharmacy resident, The Ottawa Hospital
    • Elli Polemiti, recently completed her master’s degree in nutrition and health at Wageningen University in The Netherlands
    • Sonia Hussain, medical student at the SABA University School of Medicine
    • Jessica Tang, pharmacy co-op student,  University of Waterloo
    • Stella Oh, pharmacy student, University of Toronto

Keep in Touch

Follow us on Twitter: @Deprescribing
Contact us: deprescribing@bruyere.org
Check us out online: http://www.open-pharmacy-research.ca 
Contribute to our Wikipedia page: search ‘deprescribing’

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Graphic Credits:
"Newspaper" designed by John Caserta from The Noun Project
"Announcement" designed by Oliviera Guin from The Noun Project
"Clipboard" designed by Scott Lewis from The Noun Project
"Conversation" designed by Marcio Duarte from The Noun Project