|
|
| (16 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| <div class="editorbox"> '''Original Editor '''- [[User:User Name|Debbie Kenny]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | | <div class="editorbox"> '''Original Editor '''- [[User:User Name|Debbie Kenny]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> |
| =='''Introduction'''== | | =='''Introduction'''== |
| [[File:Over prescription photo.jpg|thumb|262x262px|alt=|Over prescription]]Older people often benefit from interventional and preventative health care as this age bracket are greatest risk of multimorbidity. Unfortunately they are also at greatest risk of being treated unnecessarily for conditions that may never advance or cause symptoms. This form of health care can result in harm from use of more medicines than clinically necessary, that is overprescription of medicines.<ref>Page A, Etherton-Beer C. [https://www.sciencedirect.com/science/article/abs/pii/S0378512219300726#preview-section-introduction Undiagnosing to prevent overprescribing.] Maturitas. 2019 May 1;123:67-72. Available:https://www.sciencedirect.com/science/article/abs/pii/S0378512219300726#preview-section-introduction (accessed 28.12.2022)</ref> | | [[File:Polypharmacy.jpeg|thumb|399x399px|Polypharmacy]] |
| | Over the last 30 years, people have been prescribed increasing number of medicines, in particular [[Medication and Older People|older people]]. The reasons are manifold and include: |
|
| |
|
| Problematic polypharmacy is generally seen as the result of a cascade of prescribing <ref name=":2">McGrath K, Hajjar E.R, Kumar C, Hwang C, Salzman B. Deprescribing: A simple method for reducing polypharmacy. The Journal of Family Practice 2017;66:436-445</ref>. This cascade, often initiated when an adverse drug effect is misinterpreted as a new medical problem, leads to the prescribing of more medication to treat the initial drug-induced symptom(s). Potentially inappropriate medications (medications which should be avoided in older adults and those with certain health conditions), are also increasingly probable to be prescribed in the setting of problematic polypharmacy <ref name=":2" /><ref>Steinman M.A, Landefeld C.A, Rosenthal G.E, Berthenthal D, Sen S, Kaboli P.J. Polypharmacy and prescribing quality in older people. Journal of the American Geriatrics Society 2006;54:1516-1523</ref>.
| | * A rise in [[multimorbidity]] and ageing populations |
| | * Use of [[Evidence Based Practice (EBP)|evidence-based practice]] |
| | * Greater expectations for outcomes from patients and their families<ref name=":0">NHS UK [https://www.sps.nhs.uk/articles/understanding-polypharmacy-overprescribing-and-deprescribing/ Understanding polypharmacy, overprescribing and deprescribing] Available:https://www.sps.nhs.uk/articles/understanding-polypharmacy-overprescribing-and-deprescribing/ (accessed 29.12.2022)</ref> |
|
| |
|
| == Deprescribing ==
| | The dangers of using multiple medicines include greater chances of: |
| [[File:Drug interaction .png|frameless|591x591px|alt=|right]]Deprescribing is aplanned and supervised process of dose reduction or stopping of medication that may be causing harm, or are no longer beneficial. Deprescribing should be part of good prescribing, re-evaluating dosages periodically. Desprescription involves health care professional direction and supervision with the same level of expertise and attention that prescribing entails <ref name=":6">Reeve E, Thompson W, Farrell B. Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European Journal of Internal Medicine.2017;38:3-11.
| |
| </ref>.
| |
|
| |
|
| * According to research, there are high levels of inappropriate medication use in older adults across a variety of settings and countries, proposing that there are currently vast unrealized opportunities of deprescribing <ref>Morin L, Laroche M.L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: A systematic review. Journal of the American Medical Directors Association 2016;17:862</ref><ref>Todd A, Husband A, Andrew I, Pearson, S.A, Lindsey L, Holmes H. Inappropriate prescribing of preventative medication in patients with life-limiting illness: a systematic review. BMJ Supportive & Palliative Care 2017;7: 113–121. | | * Adverse drug experiences |
| </ref>.
| | * Hospital admissions and health care costs |
| * Research suggests that older individuals and health professionals are “eager” to undertake deprescribing <ref name=":7">Sirois C, Oullet N, Reeve E. Community-dwelling older people’s attitudes towards deprescribing in Canada. Research in Social and Administrative Pharmacy 2017'';''13:864-870. | | * Non-adherence to medication<ref name=":0" /> |
| </ref>.
| |
| Factors that contribute to successful deprescribing include significant provider effort (best if in collaboration with interdisciplinary team members.
| |
|
| |
|
| Certain medication classes can successfully be deprescribed eg vitamins, minerals, analgesics, and proton pump whereas antipsychotic agents, antidepressants, and ophthalmic preparations, prescribed by specialists, are more difficult to deprescribe. <ref>Dharmarajan TS, Choi H, Hossain N, Munasinghe U, Lakhi F, Lourdusamy D, Onuoha S, Murakonda P, Skokowska-Lebelt A, Kanagala M, Russell RO. [https://pubmed.ncbi.nlm.nih.gov/31672564/ Deprescribing as a clinical improvement focus]. Journal of the American Medical Directors Association. 2020 Mar 1;21(3):355-60.Available:https://pubmed.ncbi.nlm.nih.gov/31672564/ (accessed 28.12.2022)</ref>
| | Overprescribing may occur when: |
| | * A better alternative is available but not suggested |
| | * The drug is suitable for a condition but not the individual. |
| | * A condition alters and the medicine is no longer suitable/relevant. |
| | * The patient has ceased needing the medicine but it continues to be prescribed.<ref>BBC news [https://www.bbc.com/news/health-58639253 Overprescribing of medicines must stop, says government] Available:https://www.bbc.com/news/health-58639253 (accessed 28.12.2022)</ref> |
|
| |
|
| When Deprescribing medication(s), patients’ should be provided with sufficient knowledge of the decision to be made, have realistic expectations for outcomes and be confident in their decision <ref>Stacey D, Légaré F, Col N.F, Bennett C.L, Barry M.J, Eden K.B, Holmes-rovner M, Llewellyn-thomas H, Lyddiatt A, Thomson R, Trevena L, Wu J.H Decision aids for people facing health treatment or screening decisions. The Cochrane Database of Systematic Reviews 2014;28</ref>. Evidence suggests that patients are more willing to have a medication deprescribed if it is recommended by a health professional whom they have a relationship with <ref>Reeve E, To J, Hendrix I, Shakib S, Roberts M.S, Wiese M.D. Patient barriers to and enablers of deprescribing: a systematic review''.'' Drugs Aging 2013;30:793–807.
| | == Deprescribing == |
| </ref><ref>Linsky A, Simon S.R, Bokhour B. Patient perceptions of proactive medication discontinuation. Patient Education and Counseling 2015'';''98:220–225.
| | [[File:Drug interaction .png|591x591px|alt=|thumb|Chance of adverse reactions with multiple medications]] |
| </ref><ref>Reeve E, Low L.F, Hilmer S.N. Beliefs and attitudes of older adults and carers about deprescribing of medications. British Journal of General Practice 2016'';''66:552–60.
| | Deprescribing is the complicated process undertaken for the safe and effective withdrawal of inappropriate medication. A lot of of the evidence underpinning deprescribing is from observation, being based on the patient’s physical functioning, co-morbidities, preferences and lifestyle. |
| </ref>. The health professionals elucidated in the studies were physicians, GPs and medical specialists. Research indicates that multidisciplinary interventions are generally the most effective at reducing polypharmacy and inappropriate medication use <ref name=":6" /><ref>Kaur S, Mitchell G, Vitetta L, Roberts M.S. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging 2009'';''26:1013–28</ref>.
| |
|
| |
|
| The following videos provides an easy to follow in-depth discussion regarding the concept (6 minutes){{#ev:youtube|zjUsqABxaEs}}
| | Deprescribing: |
| ==The Potential Role of the Physiotherapist in Deprescribing==
| |
|
| |
|
| Available literature linking physiotherapy with deprescribing has focused only on the role of physiotherapy as a supplementary treatment for pain relief when reducing opioid dosage.
| | * Should be part of good prescribing, with re-evaluation of dosages periodically. |
| | * Involves health care professional direction and supervision with the same level of expertise and attention that prescribing entails <ref name=":6">Reeve E, Thompson W, Farrell B. Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European Journal of Internal Medicine.2017;38:3-11. |
| | </ref>. |
|
| |
|
| Other non-pharmacological (only with doctors input) interventions to help with deprescribing include:
| | The following videos provides an easy to follow in-depth discussion regarding the concept (6 minutes){{#ev:youtube|zjUsqABxaEs}} |
|
| |
|
| * Encouraging low-salt diets and exercise to reduce prescription of antihypertensives,
| | == Overprescribing == |
| * Psychotherapy and changing sleep habits to reduce or avoid prescription of antidepressants,
| | [[File:Pill organising safe.png|thumb|384x384px|Medications: review regularly]] |
| * Pain management and rehabilitation through physiotherapy. Literature linking physiotherapy with deprescribing has focused on the role of physiotherapy as a supplementary treatment for pain relief when reducing opioid dosage. Opioid-dose reduction can be supplemented by interdisciplinary rehabilitation programs, including physiotherapy, cognitive behavioural therapy and occupational therapy, research showeding long-term improvements in pain, functioning and emotional health <ref name=":8">Townsend C.O, Kerkvliet J.L, Bruce B.K, Rome J.D, Hooten W.M, Luedtke C.A, Hodgson J.E. A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission. Pain 2008;140:177-189.
| | Overprescribing is when people are prescribed medicines: |
| </ref><ref name=":9">Huffman K.L, Sweis G.W, Gase A, Scheman J, Covington E.C. Opioid Use 12 Months Following Interdisciplinary Pain Rehabilitation with Weaning. Pain Medicine 2013;14:1908-1917.
| |
| </ref><ref name=":10">Hooten W.M, Townsend C.O, Sletten C.D, Bruce B.K, Rome J.D. Treatment Outcomes after Multidisciplinary Pain Rehabilitation with Analgesic Medication Withdrawal for Patients with Fibromyalgia. Pain Medicine 2007;8:8-16.
| |
| </ref>. In addition, guidelines for opioid use recommend that patients with long term complex pain should have their opioid dosage regularly reviewed, with removal or reduction of opioids supplemented with non-opioid analgesics or non-drug treatments such as physiotherapy, where appropriate <ref>Kahan M, Mailis-gagnon A, Wilson L, Srivastava A. Canadian guideline for safe and effective use of opioids for chronic noncancer pain Clinical summary for family physicians. Part 1: general population. Canadian Family Physician 2011'';''57:1257-1266.
| |
| </ref><ref>Berna C, Kulich R.J, Rathmell J.P. Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice. Mayo Clinic Proceedings 2015;90:828-842</ref>.
| |
|
| |
|
| === Current non- Prescribers expected knowledge and skills of medication: ===
| | * They no longer need or want |
| The majority of physiotherapists should be able to signpost patients to where they could obtain appropriate medication advice<ref name=":18">Chartered Society of Physiotherapy. Practice Guidance for Physiotherapist Supplementary and/or Independent Prescribers in the safe use of medicines. [Internet]. London: CSP; 2016. Available from: <nowiki>http://www.csp.org.uk/publications/practice-guidance-physiotherapist-supplementary-prescribers</nowiki></ref>. | | * The medicine has greater possible harmful than beneficial effects. |
| {{#ev:youtube|caoCN-J5FEE}}<ref>Youtube. What is Pharmacokinetics? - A simple Introduction! [Internet]. 2017 [cited 15 April 2018]. Available from: <nowiki>https://www.youtube.com/watch?v=caoCN-J5FEE</nowiki></ref>
| | * When a more effective alternative is not prescribed |
| | * Where the medicine is correct for a condition but not the individual. |
| | * When a condition alters and the medicine is no longer appropriate.<ref name=":0" /> |
| | The extensiveness of polypharmacy reported in literature differs, being between 10% to 90% according to the age group, definition used, healthcare and geographical setting of the study.<ref name=":1" /> |
|
| |
|
| ==== General and Specific advice that non-prescribers can give: ==== | | == Patient Engagement == |
| General advice that can apply to the whole population may be given on the effects of medication. For example the general side effects of non-steroidal anti-inflammatory drugs (NSAIDs). While providing advice it should also be recommended that the patient should seek advice from a pharmacist or independent prescriber before altering any medication they currently take<ref name=":33">Chartered Society of Physiotherapy. Medicines, prescribing and physiotherapy [Internet]. CSP; 2016. Available from: <nowiki>http://www.csp.org.uk/publications/medicines-prescribing-physiotherapy-4th-edition</nowiki></ref>.
| | Medication reviews, joint decision-making and deprescribing rely on people becoming involved in decisions regarding their health care. Information to give patients and their carers about the medicines they are taking should be a priority, taking into account language, culture and level of health literacy.<ref>UK Government [https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1019475/good-for-you-good-for-us-good-for-everybody.pdf Good for you, good for us, good for everybody] Available:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1019475/good-for-you-good-for-us-good-for-everybody.pdf (accessed 29.12.20220</ref> |
|
| |
|
| According to the CSP, specific advice may be given to patients in certain situations, for example:
| | == Common Populations at Risk == |
| | [[File:Elderly woman.jpeg|thumb|Age: risk factor for over medicated.]] |
| | The use of multiple drugs is not always an indicator of poor drug treatment or overmedication<ref name=":12">Tamminga C. When Is Polypharmacy an Advantage?. American Journal of Psychiatry. 2011;168(7):663-663.</ref>. Appropriate medication depends on whether or not the advantages outweigh the disadvantages which is subjective to both the individual and their given condition(s). It can be very hard to predict the side-effects or clinical effects of a drug combination without testing it on the specific individual as the effects all very based on the individual's genome-specific pharmocokinetics<ref name=":12" />. |
|
| |
|
| “It would be acceptable for a physiotherapist to recommend taking paracetamol as a simple analgesic for musculoskeletal pain, as the evidence for this intervention is widespread e.g. there is a NICE guideline on the matter. Also, paracetamol is on the General Sales List (GSL) and available without supervision from an independent prescriber or pharmacist.”<ref name=":33" />
| | At risk populations include: |
|
| |
|
| Physiotherapists can recommend patients to go and seek a specific medication from their GP. ONLY IF the physiotherapists have substantial knowledge of the prescription only medication, the evidence base behind it and is working with that particular relevant patient group. If the medication is advised it MUST be followed up with the recommendation that it must be discussed with their GP <ref name=":18" /><ref name=":33" />.
| | * [[Introduction to Frailty|Frail]] |
|
| | * [[Obesity]] |
| ====Patient taking their medication incorrectly? Advice non-prescribers can give:====
| | * [[Older People - Patterns of Illness, Physiological Changes and Multiple Pathology|Elderly Populations]] |
| If a non-prescriber physiotherapist notices a patient is not taking their medication correctly, they can refer the patient to the medications instructions and remind them how and when/ dose they should be taking their medication as prescribed<ref name=":33" />. This can also apply to medication devices, e.g. an inhaler, advice can be given how to use it according to guidelines.
| | * [[Mental Health]] Patients |
| Expected adverse effects of medication? What non-prescribers can do:
| | * [[Multimorbidity]] |
| Physiotherapists can refer the patient back to the GP/pharmacists or can contact the GP directly providing information on their concerns <ref name=":3">Reznik J, Keren O, Morris J, Biran I. ''Pharmacology Handbook for Physiotherapists.'' Australia: Elsevier; 2016.
| | * Recent hospitalizations/major [[Surgery and General Anaesthetic|surgery]] |
| </ref>. | | * People seeing multiple doctors |
| ====Knowledge on Side effects and possible drug interactions====
| | * [[Oncology and Palliative Care|Terminally ill patients]] |
| Table (1) illustrates a limitedlist of the commonly prescribed medications physiotherapists may encounter with their patients, and the side effects that can occur as a result. It is important that physiotherapists are aware of these, and other common medication side effects to be able to identify these issues as they arise.
| | Sex, educational level, and [[Smoking Cessation and Brief Intervention|smoking]] apparently appear not to be related to polypharmacy.<ref name=":1">FAQs clear [https://www.faqsclear.com/what-population-is-at-risk-for-polypharmacy/ What Population Is At Risk For Polypharmacy?] Available:https://www.faqsclear.com/what-population-is-at-risk-for-polypharmacy/ (accessed 29.11.2022)</ref> |
|
| |
|
| <u>Table (1): Common medications encountered by physiotherapists and their common side effects</u><ref name=":3" /><ref>Side effects [Internet]. NHS choices. 2018 [cited 15 April 2018]. Available from: https://www.nhs.uk/conditions/anticoagulants/side-effects/</ref> <ref>Antidepressants [Internet]. NHS choices. 2018 [cited 15 April 2018]. Available from: <nowiki>https://www.nhs.uk/conditions/antidepressants/</nowiki></ref> <ref>Beta-blockers [Internet]. NHS choices. 2018. Available from: <nowiki>https://www.nhs.uk/conditions/beta-blockers/</nowiki></ref>
| | ==The Potential Role of the Physiotherapist in Deprescribing== |
| {| class="wikitable"
| | [[File:Non-pharma approaches.png|frameless|558x558px|alt=|right]] |
| !'''Type of Medication'''
| |
| !'''Purpose of Medication'''
| |
| !'''Side-Effects'''
| |
| !'''Examples'''
| |
| |-
| |
| |'''Non-steroidal anti-inflammatory drugs (NSAIDs)'''
| |
| |Analgesia- reduce pain, inflammation
| |
| |Dizziness, headache, renal impairment, gastrointestinal toxicity ulcers and/or bleeding and increased risk of cardiovascular side effects
| |
| |High dose aspirin, celecoxib, diclofenac, ibuprofen, indometacin
| |
| |-
| |
| |'''Diuretics'''
| |
| |High blood pressure (hypertension), fluid retention because of heart failure, fluid build up in the abdomen caused by liver damage
| |
| |Dizziness, headaches, increased blood sugar, muscle cramps, nausea, increase frequency to urinate
| |
| |Furosemide, bumetanide, torsemide, Edecrin
| |
| |-
| |
| |'''Opioid analgesics'''
| |
| |Moderate to severe pain
| |
| |Constipation, drowsiness, confusion, delirium, nausea, dizziness
| |
| |Codeine, tramadol morphine
| |
| Can combine with NSAIDs
| |
| |-
| |
| |'''Anticoagulants'''
| |
| |High risk of blood clots- Atrial fibrillation, stroke, Myocardial infarction, DVT, pulmonary embolism.
| |
| |Excessive bleeding, Dizziness, weakness, severe stomach and headache | |
| |Heparin, warfarin, rivaroxaban, dabigatran, apixabanm, edoxaban | |
| |- | |
| |'''Beta blockers''' | |
| |Hypertension, angina, some abnormal heart rhythms (e.g. AF), Myocardial infarction, glaucoma, overactive thyroid symptoms
| |
| |Dizziness, weakness, drowsiness, fatigue, cold hands and feet, dry mouth, skin, or eyes, headache, upset stomach, constipation, blurred vision, slowed heart rate
| |
| |Atenolol, bisoprolol, cardicor, carvedilol, metoprolol, nebivolol, propranolol
| |
| |-
| |
| |'''Angiotensin receptor blockers'''
| |
| |Hypertension, heart failure
| |
| |Dizziness, headaches, cold or flu-like symptoms, muscle weakness/ cramps
| |
| |Candesartan, irbesartan, losartan, valsartan, olmesartan
| |
| |-
| |
| |'''Angiotensin converting enzyme inhibitors (ACE)'''
| |
| |Heart failure, hypertension
| |
| |Dry cough, headaches, dizziness, hyperkalemia, hypotension
| |
| |Enalapril, lisinopril, perindopril, ramipril
| |
| |}
| |
| Table (2) demonstrates a limited list of medications that are “multi-purposeful”, meaning they can target and treat more than one issue. It is important to be aware of these medications and not to assume the patient has been prescribed the medication for the most common reason. It is also valuable to be aware of these medications for if a patient has more than one complication, it may be possible to suggest prescription of 1 medication to treat both issues, rather than 2 medications with 2 possible lists of side effects.
| |
|
| |
|
| <u> Table (2): Examples of Repurposing Drugs</u><ref name=":3" /><ref name=":36" />
| | Available literature linking physiotherapy with deprescribing has focused only on the role of physiotherapy as a supplementary treatment for pain relief when reducing opioid dosage. |
| [[File:Active drugs.png|center|frameless|860x860px]]
| |
| <ref>Babyak M, Blumenthal J, Herman S, Khatri P, Doraiswamy M, Moore K et al. Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months. Psychosomatic Medicine. 2000;62(5):633-638.</ref> <ref>Blake H. Physical activity and exercise in the treatment of depression. Frontiers in Psychiatry. 2012;3.</ref> <ref>Blumenthal J, Smith P, Hoffman B. Is Exercise a Viable Treatment for Depression?. ACSM's Health & Fitness Journal. 2012;16(4):14-21.</ref>.
| |
|
| |
|
| <u> Table (3): Most Common Medications that result in falls </u><ref>Ruxton K, Woodman R, Mangoni, A. Drugs with anticholinergic effects and cognitive impairment, falls and all‐cause mortality in older adults: A systematic review and meta‐analysis. British Journal of Clinical Pharmacology. 2015; 80(2):209-220.</ref>
| | General advice that may be given on the effects of medication. For example the general side effects of non-steroidal anti-inflammatory drugs (NSAIDs). While providing advice it should also be recommended that the patient should seek advice from a pharmacist or independent prescriber before altering any medication they currently take<ref name=":33">Chartered Society of Physiotherapy. Medicines, prescribing and physiotherapy [Internet]. CSP; 2016. Available from: <nowiki>http://www.csp.org.uk/publications/medicines-prescribing-physiotherapy-4th-edition</nowiki></ref>. |
| {| class="wikitable"
| |
| !'''Types of Medication'''
| |
| !'''Purpose'''
| |
| !'''Examples'''
| |
| |-
| |
| |'''Hypnotics and Sedatives'''
| |
| |Insomnia- induce sleep
| |
| |zaleplon, zolpidem, zopiclone
| |
| |-
| |
| |'''Antidepressants'''
| |
| |Treat depression, anxiety, PTSD, OCD
| |
| |Fluoxetine, citalopram, paroxetine, sertraline, duloxetine, venlafaxine, amitriptyline, clomipramine, imipramine
| |
| |-
| |
| |'''Benzodiazepines'''
| |
| |Severe anxiety, insomnia, seizures
| |
| |Diazepam, lorazepam, chlordiazepoxide, oxazepam, temazepam, nitrazepam, loprazolam, lormetazepam, clobazam
| |
| |}
| |
|
| |
|
| Table (3) illustrates medications that are highly correlated with falls. If a patient is becoming greatly affected by this falls side effect and is subsequently jeopardising their safety, cessation or alteration of dose may be proposed. As a non-prescriber, this can be discussed with the patient’s GP who has the authority to make such changes<ref name=":33" />. Physiotherapy interventions can be suggested in conjunction with the medication alteration to target the falls risk, or as a substitute to the purpose of the medication.
| | '''Is patient taking their medication incorrectly?:''' If a non-prescriber physiotherapist notices a patient is not taking their medication correctly, they can refer the patient to the medications instructions and remind them how and when/ dose they should be taking their medication as prescribed<ref name=":33" />. This can also apply to medication devices, e.g. an inhaler, advice can be given how to use it according to guidelines. |
| | |
| The more medications a patient takes, the risk is increased of the drugs interacting with each other <ref name=":36">Silvestrini E. Drug Interactions [Internet]. DrugWatch. 2018 [cited 15 April 2018]. Available from: <nowiki>https://www.drugwatch.com/drug-interactions/</nowiki></ref>.
| |
| | |
| Here is an easy guide video on information regarding drug interactions<ref>Youtube. Drug interaction episode 1 [Internet]. 2015 [cited 15 April 2018]. Available from: <nowiki>https://www.youtube.com/watch?v=vpoR1OiTOyU</nowiki></ref>:
| |
| | |
| {{#ev:youtube|vpoR1OiTOyU}}
| |
| == Common Populations at Risk ==
| |
| The use of multiple drugs is not always an indicator of poor drug treatment or overmedication<ref name=":12">Tamminga C. When Is Polypharmacy an Advantage?. American Journal of Psychiatry. 2011;168(7):663-663.</ref>. Appropriate medication depends on whether or not the advantages outweigh the disadvantages which is subjective to both the individual and their given condition(s). It can be very hard to predict the side-effects or clinical effects of a drug combination without testing it on the specific individual as the effects all very based on the individual's genome-specific pharmocokinetics<ref name=":12" />. At risk populations include:
| |
| | |
| * Elderly Populations
| |
| * Psychiatric Patients
| |
| * Multimorbidity
| |
| * Recent hospitalizations/major surgery
| |
| * People seeing multiple doctors
| |
| * Terminally ill patients
| |
|
| |
|
| | Adverse Effects:Physiotherapists can refer the patient back to the GP/pharmacists or can contact the GP directly providing information on their concerns re adverse effects <ref name=":3">Reznik J, Keren O, Morris J, Biran I. ''Pharmacology Handbook for Physiotherapists.'' Australia: Elsevier; 2016. |
| | </ref>. |
| == Non-Pharmacological Interventions== | | == Non-Pharmacological Interventions== |
| The use of non-pharmacological options in tackling overprescription should be considered across all allied health professionals. For physiotherapists, the vast majority of interventions utilized in practice are non-pharmacological as most clinicians are non-prescribers. It is important for physiotherapists and other relevant health care providers to be aware of the wide array of treatment options for sufficient provision of holistic patient care, to be used on their own or in conjunction with drug therapies, in effort to address clinical scenarios where overprescription may be an issue. The most common treatment for chronic pain is traditionally pharmacological<ref>Nalamachu S. An overview of pain management: the clinical efficacy and value of treatment. American journal of managed care 2013;19:261-266</ref>. Health care professionals should be aware of the benefits of non-pharmacological options with sufficient evidence bases for a range of relevant domains such as improvements in pain and functional status, as well as cognitive and emotional states.
| | Physiotherapists are reminded to stay within their scope of practice and always discuss any treatment options preferred as an alternative to drug therapies with the patient’s multidisciplinary team (MDT) or general practitioner (GP). Non-clinical readers are advised to discuss any preferable options with their GP before seeking treatment<ref>[[Non Pharmacological Interventions|Non-Pharmacological Approaches to Deprescription]]</ref>. See this page for more: [[Non Pharmacological Interventions|Non-Pharmacological Interventions]] |
| | |
| A recent 2017 study has discovered barriers to non-pharmacological options with regards to chronic pain<ref name=":17">Becker W.C, Dorflinger L, Edmond S.N, Islam L, Heapy A.A, Fraenkel L. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC Family Practice 2017;18 [online] [viewed 18/04/2018]. Available from: <nowiki>http://doi.org/10.1186/s12875-017-0608-2</nowiki>.</ref>. Top ranked patient-reported barriers included high cost, transportation problems, and low motivation. While top provider-reported barriers include scepticism about efficacy of the non-pharmacological options<ref name=":17" />. For this reason, the authors of this Physiopedia page have constructed a non-exhaustive list of common [[Non-Pharmacological Approaches to Deprescription|Non-Pharmacological Approaches]], accompanied with descriptions and mechanisms of the interventions, brief summary of the evidence base, and suggestions for referrals and signposting patients for options outside the scope of physiotherapy. Some of these options listed are covered under the National Health Service, others can be used for self-management, and some address beliefs and cognitive effects. Therefore, this resource should be used in hopes to address the high cost, transportation, and low motivation barriers of patients, while providing a brief population dependent evidence base for a wide array of non-pharmacological options so healthcare providers can be confident in their choice of treatment option in accordance with the individual values of their patient<ref name=":17" />.
| |
| | |
| The decision to seek non-pharmacological options outside conventional care, should be discussed with a patient’s general practitioner or wider multidisciplinary team, and include patient preferences and values, in order to provide safe and optimal patient-centred care. Non-Pharmacological approaches are listed for both inside and outside the scope of physiotherapy (Figure 3).
| |
| [[File:Non-pharma approaches.png|center|frameless|558x558px]] | |
|
| |
|
| == References == | | == References == |
