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      Choosing Wisely bei Patientinnen und Patienten mit Polypharmazie

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      Praxis
      Hogrefe Publishing Group

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          Abstract

          Zusammenfassung. Polypharmazie und potenziell unangebrachte Medikamente haben gravierende negative Auswirkungen auf die Gesundheit. Beim Reduzieren/Absetzen von Medikamenten (Deprescribing) stehen die Patientenwerte im Zentrum. In der Praxis hat sich folgendes schrittweises Vorgehen bewährt: 1. Alle eingenommenen Medikamente mitbringen lassen und mit der aktuellen Medikationsliste abgleichen. 2. Einen gemeinsamen Entscheidungsprozess anbieten. 3. Jedes Medikament nach Indikation, Nutzen/Schadenbilanz, Nebenwirkungen und Dosierung kritisch evaluieren. 4. Nutzen und Schaden entlang der Werte, Präferenzen und Ziele der Patientin/des Patienten priorisieren. 5. Gemeinsam über Reduzieren oder Absetzen entscheiden. 6. Die Veränderungen auf dem Medikationsplan festhalten und eine Verlaufskontrolle vereinbaren. Dieses Vorgehen wird am Beispiel einer älteren, gebrechlichen Patientin mit Polypharmazie illustriert. Deprescribing ist für das Patientenwohl ebenso wichtig wie das Verschreiben von Medikamenten!

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          Most cited references15

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          Is Open Access

          What is polypharmacy? A systematic review of definitions

          Background Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.
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            A three-talk model for shared decision making: multistage consultation process

            Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.
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              A systematic review of the emerging definition of 'deprescribing' with network analysis: implications for future research and clinical practice.

              The aim of this study was to identify what definitions have been published for the term 'deprescribing', and determine whether a unifying definition could be reached. A secondary aim was to uncover patterns between the published definitions which could explain any variation.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Praxis
                Praxis
                Hogrefe Publishing Group
                1661-8157
                1661-8165
                January 2023
                January 2023
                : 112
                : 1
                : 5-10
                Affiliations
                [1 ]Institut für Hausarztmedizin, Universität und Universitätsspital Zürich, Zürich, Schweiz
                Article
                10.1024/1661-8157/a003960
                dfac8ce2-0d2d-43d0-a4e8-df4a0d27e72d
                © 2023
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