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elderly woman deprescribingCo-led by principal investigators Barbara Farrell and James Conklin and managed by Hannah Irving, this project is developing, implementing and evaluating three “deprescribing” guidelines.

These guidelines will support interdisciplinary teams of healthcare professionals in tapering or stopping medications that may be causing harm or are no longer providing benefit as well as monitoring for adverse drug withdrawal reactions in elderly patients. The project’s research team expects that this will reduce adverse drug effects and improve quality of life.

Co-investigators: Kevin Pottie, Lalitha Raman-Wilms, Lisa McCarthy, Lise M. Bjerre

Master’s candidates: Clara Korenvain, Wade Thompson
Research assistant: David de Launay

Deprescribing guidelines and their team members

The project has assembled three teams of dedicated researchers and healthcare professionals to develop the guidelines.

Guideline team 1: Proton pump inhibitors — This team has developed a deprescribing guideline for PPIs, a class of drugs that reduce acid production in the stomach. They are commonly used to treat heartburn, among other conditions.

Guideline team 2: Benzodiazepines — This team has developed a deprescribing guideline for benzodiazepine receptor agonists, a class of drugs also called hypnotics or sedatives that are commonly prescribed for insomnia, among other conditions.

Guideline team 3: Antipsychotics — This team is developing a deprescribing guideline for antipsychotics, a class of drugs used to treat psychosis and schizophrenia, among other conditions.

Barbara Farrell • Paul Moayyedi • Kevin Pottie • Kate Walsh • Vivian Welch • Taline Boghossian • Joy Rashid • Wade Thompson • Lisa Pizzola

Kevin Pottie • Wade Thompson • Simon Davies • Jean Grenier • Cheryl Sadowski • Vivian Welch • Anne Holbrook • Cynthia Boyd • Robert Swenson • Barbara Farrell • Sonia Hussain • Andy Ma • Elli Polemiti

Lise Bjerre • Matthew Hogel • Barbara Farrell • Andrew Wiens • Genevieve Lemay • Lalitha Raman-Wilms • Lisa McCarthy • Lyla Graham • Samir Sinha • Vivian Welch • Yan Li

Purple = Team member and staff
Green = Student or pharmacy resident
Turquoise = Volunteer

Research goals
  1. To determine which consensus, development and implementation processes can be used to create and introduce deprescribing guidelines into primary and long-term care to influence the adoption and use of the practices described in the guidelines.
  2. To determine the uptake and effect, including projected savings, of deprescribing guidelines in primary and long-term care settings.
  3. To determine the effect of deprescribing guidelines on prescriber self-efficacy in discontinuing medications and patients’ acceptance of deprescribing.
Methods

This project uses both qualitative and quantitative methods to evaluate the process of developing and implementing deprescribing guidelines in three long-term care and three family health team practices in Ottawa.

Priorities for guideline development were determined through a consensus process that involves experts in geriatric medicine, long-term care, primary care, and guideline development (see the publication describing this process). Guideline development and implementation teams have been formed, and three sets of guidelines are being developed, implemented and evaluated.

A variety of research and evaluation methods are being used to ensure that the guidelines are based on a rigorous development process and are relevant and useful for deprescribers. Observations of and interviews with the guideline development teams are being used to understand the process of prioritizing and developing guidelines. Observations of and interviews with members of the site implementation teams are being employed to capture additional detail on the progress and process of guideline implementation and ongoing development.

Pre–post surveys will assess changes to physicians’ perceived self-efficacy to taper or stop medications. The patients’ perspectives and experiences of the process will be captured through semi-structured interviews.

Expected results
  • Development of feasible, effective deprescribing guidelines and support tools, such as deprescribing algorithms
  • Creation of an adaptable implementation process for use with other drugs and for implementation in a variety of healthcare contexts
  • Generation of an outcomes evaluation approach to determine clinical and economic impacts
Implications

The results of the study will help reduce medications that may be causing problems or are no longer needed for older patients. The results will help to improve medication-related health of seniors — i.e., fewer medications taken, fewer adverse drug reactions, etc. — improve the confidence of clinicians in tapering or stopping medications and support a cultural shift in healthcare toward reassessing medication use as people age.

Learn more about deprescribing

To continue this important work, Drs. Barbara Farrell and Cara Tannenbaum recently joined forces with a number of other interested colleagues to establish CaDeN — the Canadian Deprescribing Network — through a CIHR-PHSI grant to catalyze action and promote deprescribing across Canada.

Learn more about the Canadian Deprescribing Network

Deprescribing algorithms

Proton pump inhibitors

PPI deprescribing algorithm 2015

More information about the PPI deprescribing algorithm, including the user agreement, citation recommendation and translation requirements

Benzodiazepine receptor agonists

More information about the benzodiazepine deprescribing algorithm, including the user agreement, citation recommendation and translation requirements

Antipsychotics

More information about the deprescribing algorithm for antipsychotics, including the user agreement, citation recommendation and translation requirements

all deprescibing journal papers September 2016

Deprescribing journal publications
  1. Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, Rojas-Fernandez C, Walsh K,  Welch V, Moayyedi, P. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Phys, May 2017, 63(5):354–64.
  2. Thompson W, Quay TA, Rojas-Fernandez C, Farrell B, Bjerre LM. Atypical antipsychotics for insomnia: a systematic review. Sleep Med, 2016;22:13–7.
  3. Farrell B, Pottie K, Rojas-Fernandez CH, Bjerre LM, Thompson W, Welch V. Methodology for developing deprescribing guidelines: Using evidence and GRADE to guide recommendations for deprescribing. PLoS One, 2016;11(8):e0161248. doi:10.1371/journal.pone.016124.
  4. Thompson W, Hogel M, Li Y, Thavorn K, O’Donnell D, McCarthy L, Dolovich L Black C, Farrell B. Effect of a proton pump inhibitor deprescribing guideline on drug usage and costs in long-term care. JAMDA, 2016, in press, doi.org/10.1016/j.jamda.2016.04.020.
  5. Boghossian TA, Rashid FJ, Welch V, Rojas-Fernandez C, Moayyedi P, Pottie K, Walsh K, Pizzola L, Thompson W, Farrell B. Deprescribing versus continuation of chronic proton pump inhibitor use in adults (protocol). Cochrane Database Syst Rev, 2015; Issue 11, article number CD011969.
  6. Conklin J, Farrell B, Ward N, McCarthy L, Irving H, Raman-Wilms L. Developmental evaluation as a strategy to enhance the uptake and use of deprescribing guidelines: protocol for a multiple case study. Implement Sci, 2015 Jun 18;10(1):91. doi: 10.1186/s13012-015-0279-0.
  7. Farrell B, Tsang C, Raman-Wilms L, Irving H, Conklin J, Pottie K. What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: A modified Delphi process. PLOS One, 2015; 10(4):e0122246.
  8. Thompson W, Farrell B. Deprescribing: What is it and what does the evidence tell us? Canadian Journal of Hospital Pharmacy, 2013; 66(3):201–2.
Recent presentations

Ontario Centres for Learning, Research and Innovation in Long-Term Care Conference • Building Momentum for Long-Term Care • Ottawa, ON • Nov 9–10, 2015

  • Using deprescribing guidelines in long-term care: The Ottawa experience (oral)
    Farrell B, Conklin J

43rd North American Primary Care Research Group Annual Meeting • Cancun, Mexico • Oct 24–28, 2015

  • Deprescribing guidelines for the elderly: How developmental evaluation is strengthening our process (poster, abstract)
    Farrell B, Bjerre L, Conklin J, Irving H, McCarthy L, Pottie K, Raman-Wilms L, Rojas-Fernandez C, Smith K
  • Should I continue taking my proton pump inhibitor? Development and pilot testing of a patient decision aid
    Thompson W, Farrell B, Welch V, Tugwell P, Bjerre L (poster, abstract)

Ministry of Health and Long Term Care • Research to Policy Dialogues • Toronto, ON • Aug 20, 2015

  • Developing and piloting evidence-based deprescribing guidelines: Experience in long-term care and family health teams (oral)
    Farrell B

2015 Canadian Pharmacists Conference • Ottawa, ON • May 28–31, 2015

  • Deprescribing benzodiazepine receptor agonists: Evidence and practical consideration from a BZRA deprescribing guideline (oral, abstract unavailable)
    Thompson W, Farrell B, Pottie K
  • Deprescribing guidelines for the elderly: How developmental evaluation is strengthening our process (oral, abstract as PDF)
    Farrell B, Conklin J, Raman-Wilms L, Smith K, McCarthy L, Pottie K, Rojas-Fernandez C, Bjerre L
  • Deprescribing guidelines for the elderly: Preliminary outcomes of a developmental evaluation (poster, abstract as PDF)
    Farrell B, Conklin J, Irving H, McCarthy L, Pizzola L, Pottie K, Raman-Wilms L, Rojas-Fernandez C
Deprescribing in the news
More about this project