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Medication management IT, such as shared electronic medication plans (eMediplan) and the Swiss Electronic Patient Record, is increasingly rolled out across Switzerland. They can support primary care physicians and older adults to optimize medication use and reduce medication-related harm. Understanding users' expectations is essential for the implementation of medication management IT in primary care settings. This study aims to explore primary care physicians' and older adults' experiences and attitudes regarding medication management IT and identify barriers and facilitators to their use. We used a convergent mixed methods design using internet-based questionnaires and semistructured interviews with primary care physicians and older adults in Swiss primary care settings from January to August 2024. Participants included older adults aged ≥60 years who were using ≥2 prescribed medications daily, as well as primary care physicians practicing in Switzerland. Quantitative questionnaire data were analyzed using descriptive statistics to describe current use and attitudes regarding medication management IT. Qualitative data were analyzed using thematic analysis. A total of 252 older adults (n=126, 50.0% female; mean age 73, SD 7 years) and 46 primary care physicians (n=15, 32.6% female; mean age 54, SD 11 years) completed the questionnaire. Notably, 7/252 (2.8%) older adults and 21/46 (45.7%) physicians reported using shared electronic medication plans. Most older adults reported not using the Swiss Electronic Patient Record (240/252, 95.2%) but expressed willingness to adopt it to manage (164/240, 68.3%) or share (179/240, 74.6%) their health information in the future. Most physicians were open to using digital tools for medication optimization (35/46, 76.1%) or a platform to coordinate medication optimization with patients and other health care providers (29/46, 63.0%). Interviews were conducted with 19 older adults (12/19, 63.2% female; mean age 77, SD 9 years) and 16 physicians (5/16, 31.3% female). The qualitative data helped explain the quantitative findings. Older adults rarely used medication management IT, while physicians mainly used basic tools integrated into their practice information system (eg, interaction checkers). Barriers and facilitators for both groups included information about these novel technologies, accessibility, perceived need and benefit, usability and accessibility, data protection, and required time and effort. Although older adults and primary care physicians perceived advantages of medication management IT, current use remains limited. Improving access, usability, and training for all stakeholders may facilitate broader adoption and enhance medication safety in interprofessional primary care settings.

BackgroundFrailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty.MethodsA literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019.ResultsTwenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty.ConclusionSo far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.

PurposeTo describe the longitudinal change of health-related quality of life (HRQoL) over 12 months from acute hospitalization in older adults ≥ 70 years (IMMENSE study), and associated factors, to investigate how a medication optimization intervention influenced this change.MethodsThe EQ-5D-3L was used at discharge and 1, 6 and 12 months after discharge during a randomized controlled trial including 285 participants. Multilevel logistic (EQ-5D-3L dimensions) and mixed model regression (EQ-5D-3L index scores, EQ-VAS) were used to explore the longitudinal change with/without the intervention, and associations with medications, comorbidities, and socioeconomic variables. Subgroup analyses were performed for non-long and long stayers with hospitalizations < or ≥ 14 days.ResultsEQ-5D-3L index scores significantly declined after 12 months (β −0.06 [95% confidence interval (CI:) −0.10–−0.02], p = 0.003). Non-long stayers showed significant improvement 1 month from discharge (β 0.05 [0.00–0.09], p = 0.040). The number of medications and receiving home-care services were the main factors associated with reduced HRQoL. Being home-dwelling was the main factor associated with higher HRQoL. Non-long stayers of the intervention group reported significantly higher EQ-VAS than the control group (β 4.02 [0.11–7.93], p = 0.044).ConclusionWe observed no significant difference in the longitudinal change in HRQoL between the two IMMENSE study groups over 12 months after hospitalization. However, the non-long stayer subgroup analysis indicates that the intervention may have had a long-term effect on HRQoL in some of intervention patients. The number of medications and the ability to live and care for oneself should be taken into consideration when planning future patient care and health-care services.Trial registrationThe trial was registered in clinicaltrials.gov on 28/06/2016 before enrolment started (NCT02816086).

PurposeSub-optimal opioid prescribing and use is viewed as a major contributor to the growing opioid crisis. This study aims to systematically review the nature, process and outcomes of interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain (CNMP) with a particular focus on minimizing misuse of opiates.MethodsA systematic review of literature was undertaken. Search of literature using Medline, EMBASE and CINAHL databases from 2000 onwards was conducted. Screening and selection, data extraction and risk of bias assessments were undertaken by two independent reviewers. Narrative synthesis of the data was conducted.ResultsA total of 21 studies were included in the review, of which three were RCTs. Interventions included clinical (e.g. urine drug testing, opioid treatment contract, pill count), behavioural (e.g. electrical diaries about craving), cognitive behavioural treatment and/or educational interventions for patients and healthcare providers delivered as a single or as a multi-component intervention. Medication optimization outcomes included aspects of misuse, abuse, aberrant drug behaviour, adherence and non-adherence. Although all evaluations showed improvement in medication optimization outcomes, multi-component interventions were more likely to consider and to have shown improvement in clinical outcomes such as pain intensity, quality of life, psychological states and functional improvement compared to single-component interventions.ConclusionsA well-structured CNMP management programme to promote medicines optimization should include multi-component interventions delivered by a multidisciplinary team of healthcare professionals and target both healthcare professionals and patients. There was heterogeneity in definitions applied and interventions evaluated. There is a need for the development of clear and consistent terminology and measurement criteria to facilitate better comparisons of research evidence.

BackgroundAlthough support is needed, no method exists to elicit and integrate personal goals into medication optimization interventions for nursing home residents.AimTo develop and evaluate a tool to (1) elicit and evaluate residents’ personal goals during medication optimization, and (2) elicit involvement preferences regarding medication decision-making.MethodA draft was composed by the research team, on which feedback was collected through four focus groups with healthcare professionals (n = 23) and pilot interviews with residents (n = 6). The tool was then pilot tested in 11 nursing homes as means to facilitate person-centered medication reviews, focusing on feasibility, appropriateness, and meaningfulness. Evaluation was performed through interviews and focus groups with residents and healthcare professionals, and reports for executed medication reviews. Interview summaries and reports were analyzed inductively.ResultsThe RESident’s Participation in the Evaluation and Customization of Therapy tool (RESPECT-tool) was drafted as a modular approach of five modules. Pilot study results showed that the tool supported the formulation of personal goals. Goals resulted in changes in all aspects of the nursing home stay, indicating the tool’s potential to promote person-centered care. The RESPECT-tool showed value in the context of medication optimization as it allowed to determine potential links between residents’ personal goals and medication plans, and its use regularly led to medication changes.ConclusionA person-centered medication review facilitated by the RESPECT-tool holds a promising approach to medication optimization in nursing homes. Further research should assess impact on relevant outcomes like goal attainment, appropriateness of prescribing and quality of life.

Background Electronic clinical decision support systems (eCDSS), such as the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA), have become promising tools for assisting general practitioners (GPs) with conducting medication reviews in older adults. Little is known about how GPs perceive eCDSS-assisted recommendations for pharmacotherapy optimization. The aim of this study was to explore the implementation of a medication review intervention centered around STRIPA in the ‘Optimising PharmacoTherapy In the multimorbid elderly in primary CAre’ (OPTICA) trial. Methods We used an explanatory mixed methods design combining quantitative and qualitative data. First, quantitative data about the acceptance and implementation of eCDSS-generated recommendations from GPs ( n  = 21) and their patients ( n  = 160) in the OPTICA intervention group were collected. Then, semi-structured qualitative interviews were conducted with GPs from the OPTICA intervention group ( n  = 8), and interview data were analyzed through thematic analysis. Results In quantitative findings, GPs reported averages of 13 min spent per patient preparing the eCDSS, 10 min performing medication reviews, and 5 min discussing prescribing recommendations with patients. On average, out of the mean generated 3.7 recommendations (SD=1.8). One recommendation to stop or start a medication was reported to be implemented per patient in the intervention group (SD=1.2). Overall, GPs found the STRIPA useful and acceptable. They particularly appreciated its ability to generate recommendations based on large amounts of patient information. During qualitative interviews, GPs reported the main reasons for limited implementation of STRIPA were related to problems with data sourcing (e.g., incomplete data imports), preparation of the eCDSS (e.g., time expenditure for updating and adapting information), its functionality (e.g., technical problems downloading PDF recommendation reports), and appropriateness of recommendations. Conclusions Qualitative findings help explain the relatively low implementation of recommendations demonstrated by quantitative findings, but also show GPs’ overall acceptance of STRIPA. Our results provide crucial insights for adapting STRIPA to make it more suitable for regular use in future primary care settings (e.g., necessity to improve data imports). Trial registration Clinicaltrials.gov NCT03724539, date of first registration: 29/10/2018.

Deprescribing, the identification and discontinuation of medications that are no longer indicated or that cause adverse effects that outweigh clinical benefit, relies on the integration of clinical expertise and patient values using shared decision making (SDM). This case series describes the application of SDM to the process of deprescribing in patients with serious mental illness, illustrating the ways in which SDM builds a therapeutic alliance between patient, psychiatrist, family members, and other health care professionals to collaboratively develop treatment plans.

This study evaluated how real-time continuous glucose monitoring (RT-CGM) use was associated with medication use patterns and A1c changes among people with type 2 diabetes (T2D) using non-insulin therapy (NIT), basal insulin therapy (BIT), or intensive insulin therapy (IIT). We hypothesized that RT-CGM use would be associated with more frequent medication class changes and reduction in polypharmacy, alongside greater improvements in A1c compared to CGM non-use. This retrospective study analyzed US administrative claims data from the Optum Clinformatics Data Mart database between 09/01/2016 and 06/30/2024. People with T2D were divided into NIT, BIT, or IIT cohorts. Each cohort contained two groups: Dexcom RT-CGM users or CGM non-users and 1:1 propensity score matching was performed to minimize differences between the groups. We compared changes in medication use and A1c levels between RT-CGM users and CGM non-users over 12 months. Over 1.6 million people with T2D were identified prior to matching and stratified by therapy regimen as T2D-NIT, -BIT, or -IIT. After propensity score matching, the proportion of RT-CGM users taking ≥4 medications declined significantly and RT-CGM users had more net changes in their medications than CGM non-users. In addition, greater improvements in A1c were observed among RT-CGM users compared to CGM non-users in all cohorts (difference-in-differences of -0.4%, -0.5%, and -0.4% for T2D-NIT, T2D-BIT, and T2D-IIT, respectively, all p<0.0001). More RT-CGM users also achieved a mean A1c <7.0% or <8.0% at follow-up overall and among those not meeting the target at baseline. Higher rates of medication changes were associated with RT-CGM use. RT-CGM use was associated with significantly and meaningfully improved A1c levels among all T2D cohorts. The findings indicate that RT-CGM use could help all people with T2D improve their glycemia.

Conjoined twins present a rare but clinically challenging scenario requiring highly individualized pharmacologic strategies. Anatomical fusion, shared circulatory systems, and organ overlaps complicate drug absorption, distribution, metabolism, and excretion, including the neonatal intensive care unit setting and perioperative care. This review aims to synthesize current evidence and clinical experience regarding pharmacotherapy in CTs, focusing on drug selection, therapeutic drug monitoring and individualized dosing strategies based on anatomical and physiological variations. We performed a comprehensive structured literature review using PubMed database, covering the period 1970-2025, restricted to English-language publications. Case reports and reviews relevant to pharmacology in CTs were included (n = 4/93); surgical, radiological or anesthetic-only reports without pharmacologic content were excluded. We integrated these findings with two case reports involving pygopagus and thoracopagus conjoined twins treated in our tertiary referral care hospital. Key pharmacokinetic variables such as volume of distribution, renal clearance, and enteral absorption were examined in relation to the cross-circulation status. Additionally, an online quiz was conducted among clinicians to assess baseline knowledge. Our results observations suggest that drugs such as amikacin require TDM-based adjustments in the presence of cross-circulation in both subjects. Shared renal or gastrointestinal anatomy further necessitates titrated and monitored dosing regimens. Emergency medication strategies should consider whether complete, partial, or absent circulatory sharing is present. Questionnaire data revealed unexpectedly high knowledge levels among physicians and pharmacists, though further educational enhancements-such as virtual reality simulation and tailored protocols-are recommended. Pharmacologic management in CTs demands a multidisciplinary approach, close monitoring, and careful documentation. Case-based strategies and educational reinforcement can reduce risk and improve outcomes. Further research, including the establishment of central registries and the use of physiologically based pharmacokinetic modeling, is essential to inform individualized care in this very rare population.

Key summary points Aim This review aimed to identify, describe and discuss different interventions targeting medication use optimization in nursing homes and to identify research gaps. Finding Prescription of the whole medication regimen or of specific medication classes was the most studied aspect. Medication review and multidisciplinary approaches appeared to be effective strategies in reducing appropriate use, but further large-scale randomized trials are needed. Messages Efforts to optimize medication use among nursing home residents are still needed and should focus on less evaluated intervention components, specific medication classes and medication use aspects not related to prescribing. Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.