Considerations, barriers and enablers of deprescribing among healthcare professionals in Ogun State, Southwest, Nigeria: a cross-sectional survey.

BACKGROUND: Deprescribing is a clinical intervention aimed at managing polypharmacy and improving older adults' health outcomes. However, evidence suggests that healthcare professionals (HCPs) may face challenges in implementing the intervention. This study aimed to explore the considerations, barriers and enablers of deprescribing among HCPs in Southwest Nigeria. METHODS: A quantitative cross-sectional survey was carried out among consecutively sampled HCPs including physicians, pharmacists and nurses in two public tertiary healthcare hospitals in Ogun State, Southwest, Nigeria. A structured 43-item self-administered questionnaire was used to explore the participants' sociodemographics, HCPs' experience, considerations, barriers and enablers of deprescribing in older adults. The data were summarised using descriptive statistics including frequency and percentage. The Kruskal-Wallis test was used to determine differences in perceptions among the groups on a Likert scale. A p-value < 0.05 was considered significant. RESULTS: Overall, 453 copies of the questionnaire were analysed. Of the participants 204 (45.0%) were within the age group of 20-30 years; 173 (38.2%) claimed that older adults occasionally requested deprescribing of their medications. The majority (417; 92.1%) considered patients' quality of life to be very important in deprescribing; 423 (93.4%) opined that having a care goal known to members of the HCP team is an enabler for deprescribing while 308 (68.0%) disagreed or strongly disagreed that lack of incentives and remuneration for HCPs that de-prescribe is a barrier to deprescribing. There is a significant difference among the participants across professional groups on the assertion that pressure from pharmaceutical companies is a barrier to deprescribing in older adults (p = 0.037). CONCLUSIONS: The participants in this study had various considerations for deprescribing medication in older adults including patients' quality of life. Having a care goal known to every HCP involved in managing a patient is an enabler for deprescribing while the lack of incentives and remuneration for HCPs that de-prescribe may not necessarily be a barrier to deprescribing. There is a need for regulations and policies to support the identified enablers among HCPs and reduce the barriers to effective deprescribing process.

Expert consensus on clinical applicability of the American Geriatrics Society-Beers Criteria to older persons in Africa: An exploratory validation study.

RATIONALE, AIMS AND OBJECTIVES: There are currently no criteria to guide appropriate prescribing to older persons in Africa. Although the American Geriatrics Society-Beers (AGS-Beers) Criteria appear to be favoured by African researchers, there is a need to adapt its recommendations to the continent's health care systems. This study aimed to adapt the AGS-Beers recommendations to Nigerian and South African health care contexts. METHODS: A modified Delphi technique was used to explore Nigerian and South African experts' consensus on the applicability of the 2015 AGS-Beers Criteria recommendations to older persons in Africa. Thirty-two recommendations, 21 from the parent Criteria and 11 modified, were explored among 10 purposively selected medical and pharmacy experts in a predetermined two-round survey that utilized a 5-point Likert scale. Consensus was defined as a lower-limit 95% CI mean ratings of ≥3.0. RESULTS: Overall, the experts reached consensus on 62.5% (20/32) of the recommendations and 76.2% (16/21) of the parent AGS-Beers' recommendations specifically. While the experts consensually agreed that medications with strong anticholinergic effects should be generally avoided in older persons, mean = 4.11 (SD = ±1.27, 95% CI, 3.14-5.09), they could not reach a consensus on the context-specific recommendation to avoid amitriptyline in neuropathic pain mean = 3.11 (SD = ±1.05, 95% CI, 2.30-3.92). CONCLUSIONS: The 2015 AGS-Beers Criteria were adapted to the Nigerian and South African health care contexts. The adapted and the parent recommendations differed in their context specificity. The recommendations may serve as a guide to clinicians when prescribing medications to older persons in Nigeria and South Africa.

Potential inappropriate prescribing and associated factors among older persons in Nigeria and South Africa.

Background Potential inappropriate prescribing (PIP) among older persons is a global public health issue. However, trans-country data that can influence interventions on a global or regional level is scarce. Objectives To compare the prevalence of PIP and to determine the associated factors among older Nigerians and South Africans. Settings Nigerian and South African teaching hospitals. Method A retrospective evaluation of randomly selected medical charts of older persons was carried out in outpatient clinics of one University teaching hospital in both Nigeria and South Africa. Older persons aged ≥ 60 years who attended the hospitals' clinics between 1st January and 31st December 2016 and received medicine prescriptions were included. The PIP was evaluated using the 2015 American Geriatrics Society-Beers Criteria. The prevalence of PIP in both countries was compared and the associated factors for their occurrence determined using a binary logistic regression. Main outcome measure Prevalence of PIP and associated factors among older outpatients. Results A total of 680 participants were evaluated, 352 in Nigeria, mean age 69.03 (7.35) years, and 328 in South Africa, mean age 68.21 (7.42) years (95% CI - 0.28 to 1.94, p = 0.14). The PIP among Nigerian and South African participants were (124/352; 35.2%) versus (97/328; 29.6%) respectively (OR 0.77, 95% CI 0.56-1.06, p = 0.12). Hypertension was significantly associated with PIP among the Nigerians (OR 2.56, 95% CI 1.57-4.17, p = < 0.001) and South Africans (OR 3.11, 95% CI 1.17-8.24, p = 0.02) in a logistic regression. Conclusions The prevalence and pattern of PIP among Nigerian and South African participants were similar. Hypertension was an associated factor for PIP among the participants in both countries.

American Geriatrics Society-Beers Criteria and adverse drug reactions: a comparative cross-sectional study of Nigerian and South African older inpatients.

BACKGROUND: The Beers Criteria were developed with the aim of improving the safety of medicines among older persons. While the association between the Beers' list of potentially inappropriate medicines (PIMs) and adverse drug reactions (ADRs) among older Caucasians is contentious, the ability of the Criteria to predict ADRs among older persons in Africa remains unexplored. OBJECTIVES: This study aimed to compare the prevalence of PIMs and ADRs among hospitalized older persons in Nigeria and South Africa, and to determine the association between the 2015 American Geriatrics Society-Beers (AGS-Beers) PIMs and ADRs. METHODS: The medical records of older persons aged ≥60 years who were hospitalized in teaching hospitals in Nigeria and South Africa were randomly selected, and retrospectively evaluated for ADRs by two clinical pharmacists using the Naranjo algorithm. The PIMs were assessed using the 2015 AGS-Beers Criteria. A multivariate logistic regression was used to determine the associated factors for ADRs among the hospitalized older persons, with P<0.05 being considered significant. RESULTS: The samples which comprised 268 and 339 hospitalized older persons (mean age 70.53±8.22; 95% CI -0.21 to 2.32 vs mean age 69.49±7.64; 95% CI -0.25 to 2.34, P=0.11) were evaluated in Nigeria and South Africa, respectively. The PIMs among the older persons in Nigeria were 32.1% (86/268) and 30.1% (102/339, OR=0.91, 95% CI 0.64-1.29, P=0.6) for South Africa; 13.8% (37/268) of the hospitalized older persons in Nigeria experienced 43 cases of ADRs compared to 9.1% (31/339) in South Africa (95% CI 0.38-1.04, P=0.07). The multivariate analysis showed no association between PIMs and ADRs among the hospitalized older persons in Nigeria (OR=1.48 95% CI 0.70-3.17, P=0.31) and South Africa (OR=1.09, 95% CI 0.48-2.49, P=0.83). CONCLUSION: The 2015 AGS-Beers PIMs were not associated with ADRs among the hospitalized older persons in Nigeria and South Africa. However, physicians should be cautious when prescribing certain medications in the AGS-Beers list.