Deprescribing: An umbrella review.

This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where depre-scribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta--analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with deprescribing intervention trials (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with medication cessation trials (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with deprescribing intervention trials. Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of medication cessation trials, a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications.

Translation and validation of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) into the Slovenian language.

BACKGROUND: The European Health Literacy Questionnaire (HLS-EU-Q47) is a self-assessment tool for standardised measurement of health literacy. AIM: To translate HLS-EU-Q47 into the Slovenian language and to investigate its reliability and validity in Slovenia. METHOD: HLS-EU-Q47 was translated into Slovenian, back-translated, and subjected to a pilot test. The accepted Slovenian version of the questionnaire was mailed to 2500 randomly selected adult residents of the Republic of Slovenia. Reliability was examined using Cronbach's alpha for the 1-, 3-, 4-, and 12-factor models addressing health literacy, three main health contexts, four health information processing competencies, and 12 combinations, respectively. Validity was explored with confirmatory factor analysis, univariate analysis, and multiple linear regression. RESULTS: A total of 517 responses were collected (21% response rate). The highest Cronbach's alpha was obtained for the 1-factor model (0.950), followed by the 3-, 4-, and 12-factor models. In the confirmatory factor analysis, the 12-factor model provided the most valid results (CFI 0.812; RMSEA 0.067, CI 0.065 to 0.070), followed by the 3-, 4-, and 1-factor models. In the multiple regression model, only the association between self-assessment of health and the health literacy index was statistically significant (p < 0.001). CONCLUSION: The Slovenian version of HLS-EU-Q47 is a reliable instrument for measuring health literacy. All models of the questionnaire showed reasonable model fit, but none fully satisfied all validity criteria. Respondents differentiated better between the three main health contexts (health care, disease prevention, and health promotion) than the four health information processing competencies (access, understand, appraise, and apply).