How do physicians conduct medication reviews?
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ABSTRACT:
SUBMITTER: Tarn DM
PROVIDER: S-EPMC2787945 | biostudies-other | 2009 Dec
REPOSITORIES: biostudies-other
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Project description:Background: Systematic reviews (SR) can be classified by type depending on the research question they are based on. This work identifies and describes the most relevant methodological resources to conduct high-quality reviews that answer health care questions regarding prevalence, prognosis, diagnostic accuracy and effects of interventions. Methods: Methodological resources have been identified from literature searches and consulting guidelines from institutions that develop SRs. The selected resources are organized by type of SR, and stage of development of the review (formulation of the research question, development of the protocol, literature search, risk of bias assessment, synthesis of findings, assessment of the quality of evidence, and report of SR results and conclusions). Results: Although the different types of SRs are developed following the same steps, each SR type requires specific methods, differing in characteristics and complexity. The extent of methodological development varies by type of SR, with more solid guidelines available for diagnostic accuracy and effects of interventions SRs. This methodological toolkit describes the most up-to-date risk of bias instruments: Quality in Prognostic Studies (QUIPS) tool and Prediction model study Risk Of Bias Assessment Tool (PROBAST) for prognostic SRs, Quality assessment of diagnostic accuracy studies tool (QUADAS-2) for diagnostic accuracy SRs, Cochrane risk of bias tool (ROB-2) and Risk of bias in non-randomised studies of interventions studies tool (ROBINS-I) for effects of interventions SRs, as well as the latest developments on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Conclusions: This structured compilation of the best methodological resources for each type of SR may prove to be a very useful tool for those researchers that wish to develop SRs or conduct methodological research works on SRs.
| S-EPMC7542253 | biostudies-literature
Project description:ObjectivesTo develop methods guidance to support the conduct of rapid reviews (RRs) produced within Cochrane and beyond, in response to requests for timely evidence syntheses for decision-making purposes including urgent health issues of high priority.Study design and settingInterim recommendations were informed by a scoping review of the underlying evidence, primary methods studies conducted, and a survey sent to 119 representatives from 20 Cochrane entities, who were asked to rate and rank RR methods across stages of review conduct. Discussions among those with expertise in RR methods further informed the list of recommendations with accompanying rationales provided.ResultsBased on survey results from 63 respondents (53% response rate), 26 RR methods recommendations are presented for which there was a high or moderate level of agreement or scored highest in the absence of such agreement. Where possible, how recommendations align with Cochrane methods guidance for systematic reviews is highlighted.ConclusionThe Cochrane Rapid Reviews Methods Group offers new, interim guidance to support the conduct of RRs. Because best practice is limited by the lack of currently available evidence for some RR methods shortcuts taken, this guidance will need to be updated as additional abbreviated methods are evaluated.
| S-EPMC7557165 | biostudies-literature
Project description:BACKGROUND:This scoping review aims to identify, review and characterize the published recommendations to conduct and/or to report a systematic review in medical interventions area. METHODS:A search was carried out in PubMed, EMBASE and Cochrane Library databases, using systematic reviews search filters. The search comprises all recommendations to conduct and/or report a systematic review. Data on methods were extracted from each recommendation. A descriptive analysis was performed. RESULTS:Eighty-three recommendations were identified. Approximately 60% of retrieved references were published in the last 6?years. Recommendations to both conduct and report a systematic review were issued in 47% studies. The guidance presented in each recommendation to conduct and/ or report a systematic review varied. Almost 96% of the recommendations offer guidance on systematic review methods section. The need and time for updating was only recommended in 29% of recommendations. Forty percent of recommendations endorsed their methods to any subject related to medical interventions. Half of the studies did not specify the design of studies to be included in a systematic review. CONCLUSIONS:Several recommendations to conduct and/or report a systematic review were published and offered different guidance. Further research on the impact of such heterogeneity can improve systematic reviews quality.
| S-EPMC6907169 | biostudies-literature
Project description:BackgroundThe health risks associated with poor medication practices in the home suggest that patients would benefit from home-based medication reviews that could detect and resolve these issues. However, remuneration for home visits often excludes ambulatory, nonhomebound patients. A subset of these patients have issues that cannot be adequately identified and resolved during the course of a typical pharmacy-based medication review.PurposeThis study aims to characterize the prevalence and nature of "hidden in the home" medication management issues in nonhomebound patients.MethodsPharmacists facilitated subject enrollment among patients at 6 community pharmacies in Toronto over a 15-month period, from January 2016 to March 2017. Patients taking 5 or more chronic medications who were ambulatory (able to visit the pharmacy) and scored 3 points or higher on a prescreening questionnaire were invited to participate. Visits included a standard medication review, the identification of drug therapy problems and an assessment of the patient's medication and organization/storage practices, followed by a medication cabinet cleanup.ResultsOne hundred patients were recruited, with a mean age of 76.9 years and taking on average 10 chronic medications. Pharmacists identified a total of 275 drug therapy problems (2.75 per patient). The most common issues reported additional therapy required (23.6%), nonadherence (23.3%) and adverse drug reactions (17.8%). For those patients 65 years or older (87%), 32% were found to be using at least 1 medication on the Beers Criteria list, while 6% were using 3 or more. Sulfonylureas, non-steroidal anti-inflammatory drugs and short-acting benzodiazepines were the most commonly implicated drugs. Medications were removed from the homes of 67% of the patients, with expiry of medication being the most common reason for removal (54.2%). The mean duration of a home visit was 49.5 minutes.ConclusionPharmacist-directed home medication reviews offer an effective mechanism to address the pharmacotherapy issues of patients taking multiple medications. These findings highlight the frequency of medication management issues in this group and suggest that home medication reviews could serve to minimize inappropriate use of medication and maximize health care cost savings in this unique patient population. Can Pharm J (Ott) 2019;152:xx-xx.
| S-EPMC6739651 | biostudies-literature
Project description:BACKGROUND:A growing body of primary study and systematic review literature evaluates interventions and phenomena in applied and health psychology. Reviews of reviews (i.e., meta-reviews) systematically synthesise and utilise this vast and often overwhelming literature; yet, currently there are few practical guidelines for meta-review authors to follow. OBJECTIVE:The aim of this article is to provide an overview of the best practice guidelines for all research synthesis and to detail additional specific considerations and methodological details for the best practice of conducting a rigorous meta-review. METHODS:This article provides readers with six systematic and practical steps along with accompanying examples to address with rigor the unique challenges that arise when authors familiar with systematic review methods begin a meta-review: (a) detailing a clear scope, (b) identifying synthesis literature through strategic searches, (c) considering datedness of the literature, (d) addressing overlap among included reviews, (e) choosing and applying review quality tools, and (f) appropriate options for handling the synthesis and reporting of the vast amount of data collected in a meta-review. CONCLUSIONS:We have curated best practice recommendations and practical tips for conducting a meta-review. We anticipate that assessments of meta-review quality will ultimately formalise best-method guidelines.
| S-EPMC6819213 | biostudies-literature
Project description:BACKGROUND:Several recommendations are available to conduct and report a systematic review of adverse drug reactions. This study is aimed at identifying and comparing the methodologies of the two most commonly used recommendations to conduct and report systematic reviews on drug's safety. METHODS:Two systematic reviews were conducted following the recommendations "Cochrane Handbook for Systematic Reviews of Interventions" and "Systematic Reviews' Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare." The methods of each recommendation were characterized, and the results and the discussion of each systematic review were also evaluated. RESULTS:The methodologies of both recommendations are similar. The review question was structured. Both recommendations suggest to include pre- and post-marketing data. The recommended data sources differed and, consequently, the results of the systematic reviews (37 vs. 35 studies). Other aspects of search literature were identical. Different tools are suggested to evaluate the methodological quality of the included studies. For case reports, both recommendations only report some questions that may be helpful to assess risk of bias. The reporting of the results and discussion is also identical for both recommendations. CONCLUSIONS:Few methodological differences were observed between the analyzed recommendations to conduct a systematic review on drug's safety. Combining their methods into a single and recognized recommendation could be of great value.
| S-EPMC6796334 | biostudies-literature
Project description:ObjectiveMost electronic health records display historical medication information only in a data table or clinician notes. We designed a medication timeline visualization intended to improve ease of use, speed, and accuracy in the ambulatory care of chronic disease.Materials and methodsWe identified information needs for understanding a patient medication history, then applied human factors and interaction design principles to support that process. After research and analysis of existing medication lists and timelines to guide initial requirements, we hosted design workshops with multidisciplinary stakeholders to expand on our initial concepts. Subsequent core team meetings used an iterative user-centered design approach to refine our prototype. Finally, a small pilot evaluation of the design was conducted with practicing physicians.ResultsWe propose an open-source online prototype that incorporates user feedback from initial design workshops, and broad multidisciplinary audience feedback. We describe the applicable design principles associated with each of the prototype's key features. A pilot evaluation of the design showed improved physician performance in 5 common medication-related tasks, compared to tabular presentation of the same information.DiscussionThere is industry interest in developing medication timelines based on the example prototype concepts. An open, standards-based technology platform could enable developers to create a medication timeline that could be deployable across any compatible health IT application.ConclusionThe design goal was to improve physician understanding of a patient's complex medication history, using a medication timeline visualization. Such a design could reduce temporal and cognitive load on physicians for improved and safer care.
| S-EPMC7647176 | biostudies-literature
Project description:BackgroundUse of cardiovascular medication has increased over time, especially for primary and secondary prevention, with polypharmacy common.MethodsReview of published systematic reviews of the factors and outcomes associated with adherence to cardiovascular medication using MEDLINE, Embase, CINAHL and PsycINFO databases. Quality was assessed using the AMSTAR tool.ResultsOf 789 systematic reviews identified, 45 met the inclusion criteria and passed the quality assessment; 34 focused on factors associated with adherence, and 11 on outcomes. High heterogeneity, both between and within reviews, precluded meta-analysis and so a pooled estimate of adherence levels could not be derived. Adherence was associated with disease factors, therapy factors, healthcare factors, patient factors and social factors, though with some inconsistencies. In total, 91% of reviews addressing outcomes reported that low adherence was associated with poorer clinical and economic endpoints.ConclusionsFactors from across five key domains relate to non-adherence to cardiovascular medications, and may contribute to poorer clinical outcomes. Interventions to improve adherence should be developed to address modifiable factors and targeted at those at highest risk of non-adherence. Adherence research is highly heterogeneous to-date and efforts to standardize this should be implemented to improve comparability.
| S-EPMC6459362 | biostudies-literature
Project description:BackgroundAMSTAR-2 ('A Measurement Tool to Assess Systematic Reviews, version 2') and ROBIS ('Risk of Bias in Systematic Reviews') are independent instruments used to assess the quality of conduct of systematic reviews/meta-analyses (SR/MAs). The degree of overlap in methodological constructs together with the reliability and any methodological gaps have not been systematically assessed and summarized in the field of nutrition.MethodsWe performed a systematic survey of MEDLINE, EMBASE, and the Cochrane Library for SR/MAs published between January 2010 and November 2018 that examined the effects of any nutritional intervention/exposure for cancer prevention. We followed a systematic review approach including two independent reviewers at each step of the process. For AMSTAR-2 (16 items) and ROBIS (21 items), we assessed the similarities, the inter-rater reliability (IRR) and any methodological limitations of the instruments. Our protocol for the survey was registered in PROSPERO (CRD42019121116).ResultsWe found 4 similar domain constructs based on 11 comparisons from a total of 12 AMSTAR-2 and 14 ROBIS items. Ten comparisons were considered fully overlapping. Based on Gwet's agreement coefficients, six comparisons provided almost perfect (> 0.8), three substantial (> 0.6), and one a moderate level of agreement (> 0.4). While there is considerable overlap in constructs, AMSTAR-2 uniquely addresses explaining the selection of study designs for inclusion, reporting on excluded studies with justification, sources of funding of primary studies, and reviewers' conflict of interest. By contrast, ROBIS uniquely addresses appropriateness and restrictions within eligibility criteria, reducing risk of error in risk of bias (RoB) assessments, completeness of data extracted for analyses, the inclusion of all necessary studies for analyses, and adherence to predefined analysis plan.ConclusionsAmong the questions on AMSTAR-2 and ROBIS, 70.3% (26/37 items) address the same or similar methodological constructs. While the IRR of these constructs was moderate to perfect, there are unique methodological constructs that each instrument independently addresses. Notably, both instruments do not address the reporting of absolute estimates of effect or the overall certainty of the evidence, items that are crucial for users' wishing to interpret the importance of SR/MA results.
| S-EPMC8627612 | biostudies-literature
Project description:BackgroundPotentially inappropriate medication (PIM) use is a risk factor for hospitalization and mortality. However, there were few studies focusing on the impact of provider type on PIM use.ObjectiveWe aimed to estimate the initial and refill PIM prescribing rate for physician visits and nurse practitioner (NP) visits and the impact of provider type on PIM prescribing.Research designWe used 100% Texas Medicare data to define physician visits and NP visits in 2016. The rate of visits with a PIM prescription from the same provider was measured, distinguishing between initial and refill prescription to estimate the PIM rate and adjusted odds ratio (OR) by provider type.ResultsThere were 24.1 per 1000 visits with a prescription for a PIM: 9.0 per 1000 visits for an initial PIM and 15.1 per 1000 visits for a refill PIM. A visit to an NP was less likely to result in an initial (OR = 0.74, 95% confidence interval [CI] = 0.70-0.79) or refill (OR = 0.54, 95% CI = 0.51-0.57) PIM. The association of lower odds of receiving a prescription for an initial PIM from an NP was substantially stronger among black enrollees than white enrollees (OR = 0.44, 95%CI = 0.30-0.65 for blacks and OR = 0.73, 95%CI = 0.68-0.78 for white enrollees). The association of an NP provider with lower odds of receiving a PIM refill was more pronounced in older patients and in those with more comorbidities.ConclusionsNPs prescribed fewer initial PIMs and were less likely to refill a PIM after an outpatient visit than physicians. The lower odds of receiving PIMs during an NP visit varied by age, race/ethnicity, rurality, and number of comorbidities.
| S-EPMC8273104 | biostudies-literature