Intervention elements to reduce inappropriate prescribing for older adults with multimorbidity receiving outpatient care: a scoping review

ObjectivePolypharmacy occurs in approximately 30% of older adults aged 65 years or more, particularly among those with multimorbidity. With polypharmacy, there is an associated risk of potentially inappropriate prescribing (PIP). The aims of this scoping review were to (1) identify the intervention elements that have been adopted to reduce PIP in the outpatient setting and (2) determine the behaviour change wheel (BCW) intervention functions performed by each of the identified intervention elements.DesignScoping reviewData sourcesPubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Web of Science and Cochrane Library databases, grey literature sources, six key geriatrics journals and the reference lists of review papers.Study selectionAll studies reporting an intervention or strategy that addressed PIP in the older adult population (age ≥65) with multimorbidity in the outpatient setting and in which the primary prescriber is the physician.Data extractionData extracted from the included studies can be broadly categorised into (1) publication details, (2) intervention details and (3) results. This was followed by data synthesis and analysis based on the BCW framework.ResultsOf 8195 studies yielded, 80 studies were included in the final analysis and 14 intervention elements were identified. An average of two to three elements were adopted in each intervention. The three most frequently adopted intervention elements were medication review (70%), training (26.3%) and tool/instrument(s) (22.5%). Among medication reviews, 70% involved pharmacists. The 14 intervention elements were mapped onto five intervention functions: ‘education’, ‘persuasion’, ‘training’, ‘environmental restructuring’ and ‘enablement’.ConclusionPIP is a multifaceted problem that involves multiple stakeholders. As such, interventions that address PIP require multiple elements to target the behaviour of the various stakeholders. The intervention elements and their corresponding functions identified in this scoping review will serve to inform the design of complex interventions that aim to reduce PIP.

Download Full-text

Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review

BMC Geriatrics ◽

10.1186/s12877-021-02366-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shen Chen ◽

Bridie Kent ◽

Yan Cui

Keyword(s):

Older Adults ◽

Nursing Homes ◽

Scoping Review ◽

Respiratory Infections ◽

Data Extraction ◽

Nursing Home Residents ◽

Final Analysis ◽

Rehabilitation Program ◽

Cochrane Library ◽

Cognitive State

Abstract Background Dysphagia is highly prevalent condition in older adults living in nursing homes. There is also evidence indicating that aspiration is one of the major health risks for these older adults, which is more likely to result in respiratory infections, aspiration pneumonia and sudden bolus death. Evidence syntheses have demonstrated the effectiveness of interventions for prevention of aspiration among hospitalized older people. The aim of this scoping review is to describe the current spread of interventions to prevent or reduce aspiration in older adults with dysphagia with a specific focus on those who reside in nursing homes. Methods The Joanna Briggs Institute methods and PRISMA-ScR guidelines were used to inform this review. MEDLINE, CINAHL, EMBASE, Cochrane Library, Joanna Briggs Institute EBP Database and Web of Science were searched for related articles from 2010 to 2020 as well as Chinese databases (CNKI, WANFANG DATA and VIP) and databases for unpublished material. A three-step search strategy was utilized, including the use of citation software to manage search results and de-duplication, abstract review and full-text review by two reviewers. Details of included studies were then extracted using a prepared data extraction tool. The resulting map was displayed in tabular form along with a narrative summary. Results Although 637 articles were located, 19 papers were included in the final analysis. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes included: more bedside evaluation, modification of dietary, creating an appropriate environment for swallowing, providing appropriate feeding assistance, appropriate posture or maneuver for swallowing, appropriate rehabilitation program, medication treatment, and stimulation treatment. Conclusion Nursing homes, particularly those in developing countries, require more support for staff training and necessary equipment. Professional interventions provided by speech and language therapists are still limited in the setting of nursing homes. Modification of dietary was the most frequently used intervention to prevent or reduce aspiration. Multi-disciplinary interventions had the best results for aspiration management, but for many nursing homes, access to such teams is limited. Nursing home residents respond well to person-centered interventions that have a comprehensive consideration of their degree of aspiration risk, health condition, individual feelings and cognitive state.

Download Full-text

Optimising prescribing practices in older adults with multimorbidity: a scoping review of guidelines

BMJ Open ◽

10.1136/bmjopen-2021-049072 ◽

2021 ◽

Vol 11 (12) ◽

pp. e049072

Author(s):

Penny Lun ◽

Felicia Law ◽

Esther Ho ◽

Keng Teng Tan ◽

Wendy Ang ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Scoping Review ◽

Data Extraction ◽

Grey Literature ◽

Cochrane Library ◽

Prescribing Practices ◽

Usable Knowledge ◽

Study Selection ◽

The Cochrane Library

ObjectiveInappropriate polypharmacy occurs when multiple medications are prescribed without clear indications or where harms outweigh their benefits. The aims of this scoping review are to (1) identify prescribing guidelines that are available for older adults with multimorbidity and (2) to identify cross-cutting themes used in these guidelines.DesignScoping review.Data sourcesPubMed, Embase, Web of Science, the Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, grey literature sources, six key geriatrics journals, and reference lists of identified review papers. The search was conducted in November 2018 and updated in September 2019.Study selectionGeneral prescribing guidelines tailored to or for adults including older adults with multimorbidity.Data extractionData for publication description, guideline characteristics, information for users and criteria were extracted. The synthesis contains summarised qualitative descriptions of the studies and guideline characteristics as well as identified cross-cutting themes.ResultsOur search strategy yielded 10 427 unique citations, of which 70 fulfilled the inclusion criteria for synthesis. Among these, there were 61 unique guidelines and tools which used implicit, explicit, mixed or other approaches in the prescriber decision-making process. There are 11 cross-cutting themes identified in the guidelines. Prescriber-related themes are: conduct a comprehensive assessment before prescribing, identify patients’ needs, goals and priorities, adopt shared decision-making, consider evidence-based recommendations, use clinical prescribing tools, incorporate multidisciplinary inputs and embrace technology-enabled prescribing. Wider organisation-related and system-related themes related to education, training and the work environment are also identified.ConclusionsFrom guidelines and tools identified, eleven cross-cutting themes provide a usable knowledge base when seeking to optimise prescribing among older adults with multimorbidity. Incorporating these themes in an approach that uses mixed criteria and implementation information could facilitate greater uptake of published prescribing recommendations.

Download Full-text

Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-021-03371-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yasamin Veziari ◽

Saravana Kumar ◽

Matthew Leach

Keyword(s):

Alternative Medicine ◽

Complementary And Alternative Medicine ◽

Scoping Review ◽

Data Extraction ◽

Grey Literature ◽

Evidence Base ◽

Cochrane Library ◽

Educational Strategies ◽

The Cochrane Library ◽

Complementary And Alternative

Abstract Background Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM. Methods The scoping review was undertaken using the Arksey and O’Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data. Results Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers. Conclusions While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

Download Full-text

What does integrated care mean from an older person’s perspective? A scoping review

BMJ Open ◽

10.1136/bmjopen-2019-035157 ◽

2020 ◽

Vol 10 (1) ◽

pp. e035157

Author(s):

Michael T. Lawless ◽

Amy Marshall ◽

Manasi Murthy Mittinty ◽

Gillian Harvey

Keyword(s):

Older Adults ◽

Integrated Care ◽

Scoping Review ◽

Data Extraction ◽

Grey Literature ◽

Secondary Outcome ◽

Coordinated Care ◽

Healthcare Settings ◽

Care Relationships ◽

Integrated Or

ObjectiveTo systematically map and synthesise the literature on older adults’ perceptions and experiences of integrated care.SettingVarious healthcare settings, including primary care, hospitals, allied health practices and emergency departments.ParticipantsAdults aged ≥60 years.InterventionsIntegrated (or similarly coordinated) healthcare.Primary and secondary outcome measuresUsing scoping review methodology, four electronic databases (EMBASE, CINAHL, PubMed and ProQuest Dissertation and Theses) and the grey literature (Open Grey and Google Scholar) were searched to identify studies reporting on older adults’ experiences of integrated care. Studies reporting on empirical, interpretive and critical research using any type of methodology were included. Four independent reviewers performed study selection, data extraction and analysis.ResultsThe initial search retrieved 436 articles, of which 30 were included in this review. Patients expressed a desire for continuity, both in terms of care relationships and management, seamless transitions between care services and/or settings, and coordinated care that delivers quick access, effective treatment, self-care support, respect for patient preferences, and involves carers and families.ConclusionsParticipants across the studies desired accessible, efficient and coordinated care that caters to their needs and preferences, while keeping in mind their rights and safety. This review highlights the salience of the relational, informational and organisational aspects of care from an older person’s perspective. Findings are transferable and could be applied in various healthcare settings to derive patient-centred success measures that reflect the aspects of integrated care that are deemed important to older adults and their supporters.

Download Full-text

Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting – a scoping review

BMC Geriatrics ◽

10.1186/s12877-020-01766-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sabrina Lau ◽

Penny Lun ◽

Wendy Ang ◽

Keng Teng Tan ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Scoping Review ◽

Grey Literature ◽

Inappropriate Prescribing ◽

Theoretical Domains Framework ◽

Ambulatory Setting ◽

Eligibility Criteria ◽

Related Factors ◽

Prescribing Behaviour ◽

The Impact

Abstract Background As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results A total of 5731 articles were screened. Twenty-nine studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour. Conclusion The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

Download Full-text

Interventions to improve adherence to reporting guidelines in health research: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2017-017551 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017551 ◽

Cited By ~ 6

Author(s):

David Blanco ◽

Jamie J Kirkham ◽

Douglas G Altman ◽

David Moher ◽

Isabelle Boutron ◽

...

Keyword(s):

Scoping Review ◽

Health Research ◽

Data Extraction ◽

Grey Literature ◽

Reporting Guidelines ◽

Cochrane Library ◽

Improve Compliance ◽

Review Protocol ◽

Journal Policies ◽

Research Stage

IntroductionThere is evidence that the use of some reporting guidelines, such as the Consolidated Standards for Reporting Trials, is associated with improved completeness of reporting in health research. However, the current levels of adherence to reporting guidelines are suboptimal. Over the last few years, several actions aiming to improve compliance with reporting guidelines have been taken and proposed. We will conduct a scoping review of interventions to improve adherence to reporting guidelines in health research that have been evaluated or suggested, in order to inform future interventions.Methods and analysisOur review will follow the Joanna Briggs Institute scoping review methods manual. We will search for relevant studies in MEDLINE, EMBASE and Cochrane Library databases. Moreover, we will carry out lateral searches from the reference lists of the included studies, as well as from the lists of articles citing the included ones. One reviewer will screen the full list, which will be randomly split into two halves and independently screened by the other two reviewers. Two reviewers will perform data extraction independently. Discrepancies will be solved through discussion. In addition, this search strategy will be supplemented by a grey literature search. The interventions found will be classified as assessed or suggested, as well as according to different criteria, in relation to their target (journal policies, journal editors, authors, reviewers, funders, ethical boards or others) or the research stage at which they are performed (design, conducting, reporting or peer review). Descriptive statistical analysis will be performed.Ethics and disseminationA paper summarising the findings from this review will be published in a peer-reviewed journal. This scoping review will contribute to a better understanding and a broader perspective on how the problem of adhering better to reporting guidelines has been tackled so far. This could be a major first step towards developing future strategies to improve compliance with reporting guidelines in health research.

Download Full-text

Using social marketing for the promotion of cognitive health: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2021-049947 ◽

2021 ◽

Vol 11 (10) ◽

pp. e049947

Author(s):

Mathilde Barbier ◽

Caroline Schulte ◽

Anna Kornadt ◽

Carine Federspiel ◽

Jean-Paul Steinmetz ◽

...

Keyword(s):

Social Marketing ◽

Scoping Review ◽

Data Extraction ◽

Scientific Journal ◽

Grey Literature ◽

Marketing Strategies ◽

Cochrane Library ◽

Cognitive Health ◽

The Social ◽

Scoping Reviews

IntroductionThe use of social marketing strategies to induce the promotion of cognitive health has received little attention in research. The objective of this scoping review is twofold: (i) to identify the social marketing strategies that have been used in recent years to initiate and maintain health-promoting behaviour; (ii) to advance research in this area to inform policy and practice on how to best make use of these strategies to promote cognitive health.Methods and analysisWe will use the five-stage methodological framework of Arksey and O’Malley. Articles in English published since 2010 will be searched in electronic databases (the Cochrane Library, DoPHER, the International Bibliography of the Social Sciences, PsycInfo, PubMed, ScienceDirect, Scopus). Quantitative and qualitative study designs as well as reviews will be considered. We will include those articles that report the design, implementation, outcomes and evaluation of programmes and interventions concerning social marketing and/or health promotion and/or promotion of cognitive health. Grey literature will not be searched. Two independent reviewers will assess in detail the abstracts and full text of selected citations against the inclusion criteria. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart for Scoping Reviews will be used to illustrate the process of article selection. We will use a data extraction form, present the results through narrative synthesis and discuss them in relation to the scoping review research questions.Ethics and disseminationEthics approval is not required for conducting this scoping review. The results of the review will be the first step to advance a conceptual framework, which contributes to the development of interventions targeting the promotion of cognitive health. The results will be published in a peer-reviewed scientific journal. They will also be disseminated to key stakeholders in the field of the promotion of cognitive health.

Download Full-text

Barriers to Effective Prescribing in Older Adults: Applying the Theoretical Domains Framework in the Ambulatory Setting – A Scoping Review

10.21203/rs.3.rs-19415/v3 ◽

2020 ◽

Author(s):

Sabrina Lau ◽

Penny Lun ◽

Wendy Ang ◽

Keng Teng Tan ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Scoping Review ◽

Grey Literature ◽

Inappropriate Prescribing ◽

Theoretical Domains Framework ◽

Ambulatory Setting ◽

Eligibility Criteria ◽

Related Factors ◽

Prescribing Behaviour ◽

The Impact

Abstract Background: As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. Results: A total of 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as “Knowledge”, “Skills”, and “Social/Professional Role and Identity”; issues with “Environmental Context and Resources”; and the impact of “Social Influences” and “Emotion” on prescribing behaviour. Conclusion: The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.

Download Full-text

Bridging knowledge, policies and practices across the ageing and disability fields: a protocol for a scoping review to inform the development of a taxonomy

BMJ Open ◽

10.1136/bmjopen-2017-016741 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016741 ◽

Cited By ~ 2

Author(s):

Emily Joan Nalder ◽

Michelle Putnam ◽

Luis Salvador-Carulla ◽

Andria Spindel ◽

Zinnia Batliwalla ◽

...

Keyword(s):

Scoping Review ◽

Qualitative Content Analysis ◽

Data Extraction ◽

Grey Literature ◽

Knowledge Exchange ◽

Cochrane Library ◽

Data Abstraction ◽

Conference Presentations ◽

Data Extraction Form ◽

The Cochrane Library

IntroductionBridging is a term used to describe activities, or tasks, used to promote collaboration and knowledge exchange across fields. This paper reports the protocol for a scoping review which aims to identify and characterise peer reviewed evidence describing bridging activities, between the ageing and disability fields. The purpose is to clarify the concepts underpinning bridging to inform the development of a taxonomy, and identify research strengths and gaps.MethodsA scoping review will be conducted. We will search Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycInfo, Sociological Abstracts and the Cochrane Library, to identify peer reviewed publications (reviews, experimental, observational, qualitative designs and expert commentaries) describing bridging activities. Grey literature, and articles not published in English will be excluded. Two investigators will independently complete article selection and data abstraction to minimise bias. A data extraction form will be iteratively developed and information from each publication will be extracted: (1) bibliographic, (2) methodological, (3) demographic, and (4) bridging information. Qualitative content analysis will be used to describe key concepts related to bridging.ConclusionsTo our knowledge, this will be the first scoping review to describe bridging of ageing and disability knowledge, services and policies. The findings will inform the development of a taxonomy to define models of bridging that can be implemented and further evaluated to enable integrated care and improve systems and services for those ageing with disability.Ethics and disseminationEthics is not required because this is a scoping review of published literature. Findings will be disseminated through stakeholder meetings, conference presentations and peer reviewed publication.

Download Full-text

Patient-centred infertility care: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-032266 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032266

Author(s):

Hana Hasan Webair ◽

Tengku Alina Tengku Ismail ◽

Shaiful Bahari Ismail ◽

Norhayati Mohd Noor

Keyword(s):

Scoping Review ◽

Literature Search ◽

Data Extraction ◽

Grey Literature ◽

Decision Makers ◽

Cochrane Library ◽

Quality Healthcare ◽

Study Selection ◽

History Of ◽

Review Protocol

IntroductionPatient-centred infertility care (PCIC) is one of the quality indicators of effective fertility care. The application of this indicator requires a clear definition from the patient’s perspective. This proposed scoping review aims to explore the extent and nature of published scientific literature on PCIC in the past decade, identify gaps in the literature and define PCIC from infertile patients’ perspectives.Methods and analysisWe will conduct the proposed scoping review following the method of Arksey and O’Malley. The literature search will include studies published from 2009 to 2019, and will be conducted on the MEDLINE, PsycINFO, Scopus, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases; reference lists will be mined for literature not contained on these databases. A grey literature search will also be conducted. To be included in the review, studies should have been conducted on people with a history of infertility, with a focus on patient-centred fertility care. Studies that have not been published in full text and studies published in languages other than English will be excluded. After study selection, data will be charted in a prepared form. We will analyse the data using descriptive numerical and qualitative thematic analyses to answer the research questions. NVivo V.12 will be used for data extraction.Ethics and disseminationThis work does not warrant any ethical or safety concerns. This scoping review will synthesise existing literature on PCIC, and the results will be published to be readily available for clinical audiences and policymakers. These findings may support clinicians and decision-makers in applying PCIC, thereby promoting high-quality healthcare in the concerned population.

Download Full-text