Patients' and Caregivers' Attitudes Toward Deprescribing in Singapore.

BACKGROUND: Knowledge of decision-making preference of patients and caregivers is needed to facilitate deprescribing. This study aimed to assess the perspectives of caregivers and older adults towards deprescribing in an Asian population. Secondary objectives were to identify and compare characteristics associated with these attitudes and beliefs. METHOD: A cross-sectional survey of two groups of participants was conducted using the Revised Patients' Attitudes Towards Deprescribing questionnaire. Descriptive results were reported for participants' characteristics and questionnaire responses from four factors (belief in medication inappropriateness, medication burden, concerns about stopping, and involvement) and two global questions. Correlation between participant characteristics and their responses was analyzed. RESULTS: A total of 1,057 (615 older adults; 442 caregivers) participants were recruited from 10 institutions in Singapore. In which 511 (83.0%) older adults and 385 (87.1%) caregivers reported that they would be willing to stop one or more of their medications if their doctor said it was possible, especially among older adults recruited from acute-care hospitals (85.3%) compared with older adults in community pharmacies (73.6%). Individuals who take more than five medications and those with higher education were correlated with greater agreement in inappropriateness and involvement, respectively. CONCLUSIONS: Clinicians should consider discussing deprescribing with older adults and caregivers in their regular clinical practice, especially when polypharmacy is present. Further research is needed into how to engage older adults and caregivers in shared decision making based on their attitudes toward deprescribing.

Attitudes, knowledge and views on off-label prescribing in children among healthcare professionals in Malaysia.

Background Off-label prescribing in children is associated with several prerequisites such as ensuring sound and scientific evidence and obtaining written consent prior to use of off-label drugs to ensure that protection is provided to patients and healthcare professionals. Adherence to the pre-requisites depends on the attitude, views and knowledge of the pharmacists and doctors involved in this practice. Objective To explore the attitudes, knowledge and views on off-label prescribing in children among hospital-based pharmacists and paediatric doctors. Setting The study was conducted in a 620-bedded general hospital located in the urban area of central Peninsular Malaysia. Method Face to face, semi-structured interviews with 12 pharmacists and 12 paediatric doctors. Interviews were audio-recorded, transcribed and analysed using constant comparison method. Main outcome measure Themes surrounding hospital-based pharmacists' and paediatric doctors' attitude, knowledge and views on off-label prescribing in children. Results Four themes were derived: knowledge on off-label prescribing in children, views on off-label prescribing in children, attitude towards off-label prescribing in children and guidance on off-label prescribing in children. Conclusion There is a need to increase the knowledge of hospital-based pharmacists and paediatric doctors and address several concerns on off-label prescribing in children. The decision to prescribe or dispense off-label drugs involved collective decision-making mechanisms and guidance is required with regards to offlabel prescribing in children.

Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis.

OBJECTIVES: Deprescribing is effective in addressing concerns relating to polypharmacy in residents of nursing homes. However, the clinical outcomes of deprescribing interventions among residents in nursing homes are not well understood. We evaluated the impact of deprescribing interventions by health care professionals on clinical outcomes among the older residents in nursing homes. DESIGN: Systematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials. (PROSPERO CRD42016050028). SETTING AND PARTICIPANTS: Randomized controlled trials in a nursing home setting that included participants of at least 60 years of age. MEASURES: Falls, all-cause mortality, hospitalization, and potentially inappropriate medication were assessed in the meta-analysis. RESULTS: A total of 41 randomized clinical studies (18,408 residents) that examined deprescribing (defined as either medication discontinuation, substitution, or reduction) in nursing were identified. Deprescribing interventions significantly reduced the number of residents with potentially inappropriate medications by 59% (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.19-0.89). In subgroup analysis, medication review-directed deprescribing interventions reduced all-cause mortality by 26% (OR 0.74, 95% CI 0.65-0.84), as well as the number of fallers by 24% (OR 0.76, 95% CI 0.62-0.93). CONCLUSIONS: Compared to other deprescribing interventions, medication review-directed deprescribing had significant benefits on older residents in nursing homes. Further research is required to elicit other clinical benefits of medication review-directed deprescribing practice.

Two decades of off-label prescribing in children: a literature review.

BACKGROUND: In the past two decades, many legislative and regulatory initiatives were taken globally to improve drug use in children. However, children are still found to be prescribed with off-label drugs. This study was conducted to provide an overview of the worldwide trend in off-label prescribing in children from the year 1996 to 2016. DATA SOURCES: The articles published in PubMed, MEDLINE and Google Scholar were searched using text words: off-label, unlicensed, paediatric and children. Additional articles were identified by reviewing the bibliography of the retrieved articles. Full-text articles published in English which reported on the prevalence of off-label prescribing in children between January 1996 and December 2016 were included. RESULTS: A total of 101 studies met the inclusion criteria. Off-label prescribing definition included four main categories: age, indication, dose and route of administration. The three most common reference sources used in the studies were summary of product characteristics, national formularies and package inserts. Overall, the off-label prescribing rates in children ranged from 1.2 to 99.7%. The most common category of off-label prescribing in children was dose and age. CONCLUSIONS: This review highlighted that off-label prescribing in children was found to be highly prevalent throughout the past two decades, persistently in the neonatal intensive care units. This suggests that besides legislative and regulatory initiatives, behavioural, knowledge aspects and efforts to integrate evidence into practice related to off-label prescribing also need to be evaluated and consolidated as part of the concerted efforts to narrow the gaps in prescribing for children.

Do South Australian pharmacy interns have the educational and behavioural precursors to meet the objectives of Australia's health care reform agenda?

OBJECTIVE: To explore South Australian (SA) pharmacy interns' values, beliefs and motivations to study pharmacy and their assessment of how well their pharmacy education has prepared them for activities required of all health professionals under Australia's health care reforms. METHODS: A postal questionnaire was sent to all 136 SA pharmacy interns enrolled in SA intern training programmes in February 2010 (second month of the intern training programme). KEY FINDINGS: Sixty (44%) of SA pharmacy interns responded; 75% selected pharmacy as a career because of an interest in health-related sciences and 65% valued working with patients. Respondents believed their pharmacy education prepared them for patient care (80%), providing medicine information (72%) and primary health care delivery (68%), but 51% indicated that they were not prepared for multidisciplinary team care. CONCLUSIONS: The positive values, beliefs and motivations expressed by respondents are significant behavioural precursors to meet the requirements of health professionals in Australia's health care reforms. Respondents indicated that their pharmacy education provided appropriate training in a number of relevant professional areas.

Why do Australian registered pharmacists leave the profession? a qualitative study.

BACKGROUND: Understanding why people choose to leave their professions is important to inform workforce planning to meet community needs. Poor job satisfaction has been linked to health practitioners expressing intentions to leave in other professions such as nursing, occupational therapy and medicine, but little is known about the reasons why pharmacists leave their profession. OBJECTIVE: To explore reasons why Australian pharmacists leave the profession. SETTING: As part of a survey of the Australian pharmacist workforce, a questionnaire was mailed to all registered pharmacists (n = 7,764) on the registers of the Pharmacy Boards of Victoria and South Australia; 1,627 (21 %) responded. Participants, who were registered but no longer working as a pharmacist, were asked to provide contact details if they were willing to be interviewed for this study; 89 (5.5 %) pharmacists accepted an invitation. A proportionate sample of 20 was selected for the interview. METHOD: A semi-structured interview schedule was developed with probe options which encouraged participants to further explore their responses to questions. De-identified audio records of interviews were transcribed verbatim and thematically analysed. MAIN OUTCOME MEASURE: Reasons why pharmacists leave the pharmacy profession. RESULTS: Five themes emerged: (1) Dissatisfaction with the professional environment; (2) lack of career paths and opportunities; (3) under-utilisation of pharmacists' knowledge and skills; (4) wanting a change; and (5) staying connected with pharmacy. CONCLUSION: These findings provide insights to the pharmacy sector, previously unexplored in Australia, and informs future pharmacist workforce planning. To retain experienced, mid-career pharmacists in the profession, strategies to increase opportunities for career progression, better use of pharmacists' knowledge and skills and involvement in patient care are required to increase job satisfaction and improve retention rates.

The Australian pharmacist workforce: employment status, practice profile and job satisfaction.

OBJECTIVE: The aims were to determine Australian registered pharmacists' current employment status, practice profile and professional satisfaction. METHOD: A questionnaire was mailed to all registered pharmacists (n=7764) on the Pharmacy Boards of Victoria and South Australia's registers; 19 were returned undeliverable. Quantitative data were entered and analysed using the Statistical Package for Social Sciences Version 17. Qualitative data were subjected to a thematic analysis. RESULTS: 1627 (21%) pharmacists responded: 259 (16%) were registered as pharmacists but no longer worked in the pharmacy profession. A total of 1366 respondents reported still working as pharmacists. Of the 1366, 912 (67%) indicated that they spend most of their time in a clinical area; 233 (17%) spend most of their time in 'non-clinical pharmacist work (i.e. dispensing as technical supply)'; 216 (16%) worked in other non-clinical roles and; 1053 (77%) were professionally satisfied. CONCLUSION: Measuring the pharmacist workforce based on registration data significantly overestimates the available clinical pharmacist workforce: 708 (44%) respondents were no longer working in the profession, were not mainly involved in clinical practice or were working in non-clinical roles. A significant re-professionalisation program is needed if pharmacists' unique knowledge and skills are to contribute to better healthcare delivery.

Pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles.

OBJECTIVE: To explore pharmacists' awareness of Australia's health care reforms and their beliefs and attitudes about their current and future roles. METHODS: Four focus groups were conducted with 32 South Australian pharmacists: two groups included community pharmacists and pharmacy owners; one included hospital pharmacists and another, consultant pharmacists. KEY FINDINGS: Four themes emerged: (1) poor awareness of health care reform agenda; (2) strong adherence to the supply model; (3) lack of appreciation of alternative models; and (4) communication barriers. CONCLUSIONS: Participants' low awareness of Australia's health care reforms and their expressed beliefs and attitudes to their current role in the health system suggest that they are not well prepared for the potential future roles expected of health professionals in the health care reform agenda.