International journal of clinical pharmacy
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Deprescribing is the process of medication withdrawal with the aims of reducing the harms of potentially inappropriate medication use and improving patient outcomes. Deprescribing of statins may be indicated for some older people, because the evidence for benefit in primary prevention of cardiovascular disease is limited and there is an increased risk of side effects in old age. ⋯ The majority of older inpatients using statins are willing to have one or more of their current medications, including statins, deprescribed. These findings can be used to inform clinical practice and interventional statin deprescribing studies to optimise medication use in older adults.
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Diabetes is an emerging chronic disease in developing countries. Currently the management of diabetes in developing countries is mainly hospital or clinic based. With burgeoning numbers of patients with diabetes, other models need to be evaluated for service delivery in developing countries. Community pharmacists are an important option for provision of diabetes care. Currently, data regarding practices of community pharmacists in diabetes care have been limited to developed countries. ⋯ Most community pharmacies in Surabaya, Indonesia have only provided a basic service of dispensing for type 2 diabetes patients. Many pharmacists believed that they should extend their roles particularly regarding patient education and monitoring. The development of pharmacist professional roles would assist in managing the burgeoning burden of diabetes. The identified facilitators/barriers provide baseline data to support the development of community pharmacy-based diabetes services.
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There is a need to critically appraise clinical practice guidelines in order to ensure safe and effective practices are being implemented to optimize patient care. Appraising guidelines within one therapeutic area enable recommendations for improvement during guideline creation and dissemination. ⋯ The majority of appraised guidelines were moderately rated, with a 25% of guidelines not recommended for use. Strategies for improvement require the involvement of all key stakeholders (caregivers, patients, and allied health professionals), and consideration of facilitators, barriers and resource implications during implementation. Additionally, critical appraisal of guidelines should become standard practice prior to adoption into clinical settings.
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Guidelines recommend patients diagnosed with transient ischaemic attack (TIA) or ischaemic stroke receive antihypertensive, antithrombotic and lipid lowering medicines. Reassessment of the need for medicines associated with an increased risk of stroke is also recommended. ⋯ Changes to pharmacotherapy after TIA or ischaemic stroke were consistent with treatment for stroke risk factors and common stroke-related complications. Use of secondary stroke prevention medicines may be further improved among TIA patients.
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In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination with doses and route of administration. ⋯ Nearing the end of life, patients in this palliative care centre receive discomfort-relieving drugs mainly via the subcutaneous route. However, most of these drugs are unlicensed for this specific application and guidelines are based on low level of evidence. Thus, there is every reason for more clinical research on drug use in palliative care.