Barriers to Effective Prescribing in Older Adults: Applying the Theoretical Domains Framework in the Ambulatory Setting

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.

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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.

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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.

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Barriers to Effective Prescribing in the Elderly: Applying the Theoretical Domains Framework in the Ambulatory Setting

10.21203/rs.3.rs-19415/v1 ◽

2020 ◽

Author(s):

Sabrina Lau ◽

Penny Lun ◽

Wendy Ang ◽

Keng Teng Tan ◽

Yew Yoong Ding

Keyword(s):

Delphi Study ◽

Grey Literature ◽

Inappropriate Prescribing ◽

Theoretical Domains Framework ◽

The Elderly ◽

Ambulatory Setting ◽

Eligibility Criteria ◽

Related Factors ◽

Prescribing Behaviour ◽

The Impact

Abstract Aims: As the population ages, potentially inappropriate prescribing (PIP) in the elderly 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 in the elderly in the ambulatory setting.Methods: A scoping review was performed based on the five-stage methodological framework developed by Arksey and O’Malley. Our search strategy included 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: 5,731 articles were screened. 29 studies met the selection criteria for qualitative analysis. Using TDF, 14 domains for barriers to effective prescribing were identified. 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 in elderly patients in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Moving forward, we will perform a Delphi study to explore individual domains and ultimately develop a physician-pharmacist collaborative care intervention to guide prescribing for the elderly in the ambulatory setting.

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Measuring frailty in younger populations: a rapid review of evidence

BMJ Open ◽

10.1136/bmjopen-2020-047051 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047051

Author(s):

Gemma F Spiers ◽

Tafadzwa Patience Kunonga ◽

Alex Hall ◽

Fiona Beyer ◽

Elisabeth Boulton ◽

...

Keyword(s):

Patient Outcomes ◽

Predictive Validity ◽

Data Extraction ◽

Grey Literature ◽

Frailty Index ◽

Study Data ◽

Rapid Review ◽

Eligibility Criteria ◽

Adult Age ◽

The Impact

ObjectivesFrailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care.DesignA rapid review of primary studies was conducted.Data sourcesFour databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020.Eligibility criteriaEligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English.Data extraction and synthesisRecords were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach.ResultsWe identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18–59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care.ConclusionsLimited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.

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LO84: The incidence of fall-related intracranial bleeding in older adults taking anticoagulants, antiplatelets and neither medication: a meta-analysis

CJEM ◽

10.1017/cem.2020.138 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S38-S38

Author(s):

K. de Wit ◽

D. Nishijima ◽

S. Mason ◽

R. Jeanmonod ◽

S. Parpia ◽

...

Keyword(s):

Older Adults ◽

Meta Analysis ◽

Grey Literature ◽

Random Effect ◽

Intracranial Bleeding ◽

Inclusion Criteria ◽

Antiplatelet Medication ◽

Cochrane Database ◽

Random Effect Models ◽

Anticoagulant Medication

Introduction: It is unclear whether anticoagulant or antiplatelet medications increase the risk for intracranial bleeding in older adults after a fall. Our aim was to report the incidence of intracranial bleeding among older adults presenting to the emergency department (ED) with a fall, among patients taking anticoagulants, antiplatelet medications, both medications and neither medication. Methods: This was a systematic review and meta-analysis, PROSPERO reference CRD42019122626. Medline, EMBASE (via OVID 1946 - July 2019), Cochrane, Database of Abstracts of Reviews of Effects databases and the grey literature were searched for studies reporting on older adults who were evaluated after a fall. We included prospective studies conducted in the ED where more than 80% of the cohort were 65 years or older and had fallen. We contacted study authors for aggregate data on intracranial bleeding in patients prescribed anticoagulant medication, antiplatelet medication and neither medication. Incidences of intracranial bleeding were pooled using random effect models, and I2 index was used to assess heterogeneity. Results: From 7,240 publication titles, 10 studies met inclusion criteria. The authors of 8 of these 10 studies provided data (on 9,489 patients). All studies scored low or moderate risk of bias. The pooled incidence of intracranial bleeding among patients taking an anticoagulant medication was 5.1% (n = 5,016, 95% Confidence Interval (CI): 4.1 to 6.3%) I2 = 42%, a single antiplatelet 6.4% (n = 2,148, 95% CI: 5.4 to 7.6%) I2 = 75%, both anticoagulant and antiplatelet medications 5.9% (n = 212, 95% CI: 1.3 to 13.5%) I2 = 72%, and neither of these medications 4.8% (n = 1,927, 95% CI: 3.5 to 6.2%) I2 = 50%. A sensitivity analysis restricted to patients who had a head CT in the ED reported incidences of 6.1% (n = 3,561, 95% CI: 3 to 8.3%), 8.4% (n = 1,781, 95% CI: 5.5 to 11.8%), 6.7% (n = 206, 95% CI 1.5 to 15.2%) and 6.6% (n = 1,310, 95% CI: 5.0 to 8.4%) respectively. Conclusion: The incidence of fall-related intracranial bleeding in older ED patients was similar among patients who take anticoagulant medication, antiplatelet medication, both and neither medication, although there was heterogeneity between study findings.

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Scoping review of mental health in prisons through the COVID-19 pandemic

BMJ Open ◽

10.1136/bmjopen-2020-046547 ◽

2021 ◽

Vol 11 (5) ◽

pp. e046547

Author(s):

Luke Johnson ◽

Kerry Gutridge ◽

Julie Parkes ◽

Anjana Roy ◽

Emma Plugge

Keyword(s):

Mental Health ◽

Scoping Review ◽

Grey Literature ◽

Well Being ◽

Health Impact ◽

Poor Quality ◽

Eligibility Criteria ◽

Prison Staff ◽

The Impact

ObjectiveTo examine the extent, nature and quality of literature on the impact of the COVID-19 pandemic on the mental health of imprisoned people and prison staff.DesignScoping review.Data sourcesPubMed, Embase, CINAHL, Global Health, Cochrane, PsycINFO, PsychExtra, Web of Science and Scopus were searched for any paper from 2019 onwards that focused on the mental health impact of COVID-19 on imprisoned people and prison staff. A grey literature search focused on international and government sources and professional bodies representing healthcare, public health and prison staff was also performed. We also performed hand searching of the reference lists of included studies.Eligibility criteria for selection of studiesAll papers, regardless of study design, were included if they examined the mental health of imprisoned people or prison staff specifically during the COVID-19 pandemic. Imprisoned people could be of any age and from any countries. All languages were included. Two independent reviewers quality assessed appropriate papers.ResultsOf 647 articles found, 83 were eligible for inclusion, the majority (58%) of which were opinion pieces. The articles focused on the challenges to prisoner mental health. Fear of COVID-19, the impact of isolation, discontinuation of prison visits and reduced mental health services were all likely to have an adverse effect on the mental well-being of imprisoned people. The limited research and poor quality of articles included mean that the findings are not conclusive. However, they suggest a significant adverse impact on the mental health and well-being of those who live and work in prisons.ConclusionsIt is key to address the mental health impacts of the pandemic on people who live and work in prisons. These findings are discussed in terms of implications for getting the balance between infection control imperatives and the fundamental human rights of prison populations.

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Measuring gender-based violence risk mitigation in humanitarian settings: results from a comprehensive desk review and systematic mapping

BMJ Open ◽

10.1136/bmjopen-2021-050887 ◽

2021 ◽

Vol 11 (9) ◽

pp. e050887

Author(s):

Jocelyn TD Kelly ◽

Emily Ausubel ◽

Emma Kenny ◽

Meredith Blake ◽

Christine Heckman ◽

...

Keyword(s):

Risk Mitigation ◽

Grey Literature ◽

Monitoring And Evaluation ◽

Sufficient Information ◽

Gender Based Violence ◽

Systematic Mapping ◽

Eligibility Criteria ◽

Humanitarian Response ◽

Gender Based ◽

The Impact

ObjectivesTo systematically document measurement approaches used in the monitoring and evaluation of gender-based violence (GBV) risk mitigation activities, categorise the types of available literature produced by sector, identify existing tools and measures and identify knowledge gaps within the humanitarian sector.DesignSystematic mapping and in-depth review.Data sources: Pubmed, Global Health, PsychInfo, ReliefWeb, OpenGrey (grey literature), Google Scholar, Web of Science (Social Science Index)Eligibility criteria: a structured search strategy was systematically applied to 17 databases as well as registers, websites and other resources to identify materials published between 1 January 2005 and 15 May 2019.Data extraction and synthesis: Those resources that met the inclusion criteria underwent a comprehensive full-text review. A detailed matrix was developed and key data from each resource were extracted to allow for the assessment of patterns in thematic areas.ResultsA total of 2108 documents were screened. Overall, 145 documents and 112 tools were reviewed, representing 10 different humanitarian sectors. While numerous resources exist, many lack sufficient information on how to monitor outputs or outcomes of GBV risk mitigation activities. There is also limited guidance on how to integrate the measurement of GBV risk mitigation into existing monitoring and evaluation frameworks. Those reports that aimed to measure GBV risk mitigation activities mostly employed qualitative methods and few measured the impact of a GBV risk mitigation with robust research designs.ConclusionsRecent efforts to adapt humanitarian response to COVID-19 have highlighted new and existing challenges for GBV risk mitigation. There is a significant gap in the evidence base around the effectiveness of GBV risk mitigation across all sectors. Understanding and strengthening measurement approaches in GBV risk mitigation remains a critical task for humanitarian response.

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Search for unpublished data by systematic reviewers: an audit

BMJ Open ◽

10.1136/bmjopen-2017-017737 ◽

2017 ◽

Vol 7 (10) ◽

pp. e017737 ◽

Cited By ~ 10

Author(s):

Hedyeh Ziai ◽

Rujun Zhang ◽

An-Wen Chan ◽

Nav Persaud

Keyword(s):

Publication Bias ◽

Systematic Reviews ◽

Data Extraction ◽

Grey Literature ◽

Cochrane Library ◽

Eligibility Criteria ◽

Ovid Medline ◽

Cochrane Reviews ◽

Unpublished Studies ◽

Cochrane Database

ObjectivesWe audited a selection of systematic reviews published in 2013 and reported on the proportion of reviews that researched for unpublished data, included unpublished data in analysis and assessed for publication bias.DesignAudit of systematic reviews.Data sourcesWe searched PubMed and Ovid MEDLINE In-Process & Other Non-Indexed Citations between 1 January 2013 and 31 December 2013 for the following journals:Journal of the American Medical Association,The British Medical Journal,Lancet,Annals of Internal Medicineand theCochrane Database of Systematic Reviews. We also searched the Cochrane Library and included 100 randomly selected Cochrane reviews.Eligibility criteriaSystematic reviews published in 2013 in the selected journals were included. Methodological reviews were excluded.Data extraction and synthesisTwo reviewers independently reviewed each included systematic review. The following data were extracted: whether the review searched for grey literature or unpublished data, the sources searched, whether unpublished data were included in analysis, whether publication bias was assessed and whether there was evidence of publication bias.Main findings203 reviews were included for analysis. 36% (73/203) of studies did not describe any attempt to obtain unpublished studies or to search grey literature. 89% (116/130) of studies that sought unpublished data found them. 33% (68/203) of studies included an assessment of publication bias, and 40% (27/68) of these found evidence of publication bias.ConclusionA significant fraction of systematic reviews included in our study did not search for unpublished data. Publication bias may be present in almost half the published systematic reviews that assessed for it. Exclusion of unpublished data may lead to biased estimates of efficacy or safety in systematic reviews.

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Recruiting Older Adults With Cognitive Impairments for a Smartphone Intervention During COVID-19

Innovation in Aging ◽

10.1093/geroni/igab046.124 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 34-34

Author(s):

Stacey Schepens Niemiec ◽

Lon Schneider ◽

Jeanine Blanchard ◽

Rafael Wagas ◽

Liberty Teodoro ◽

...

Keyword(s):

Older Adults ◽

Digital Divide ◽

Scientific Community ◽

Cognitive Impairments ◽

Smartphone App ◽

Study Participation ◽

Related Factors ◽

Participant Engagement ◽

The Impact ◽

Smartphone Intervention

Abstract The Coronavirus disease 2019 (COVID-19) pandemic has introduced numerous challenges to the global scientific community and has been particularly disruptive to the conduct of ongoing clinical trials. Gerontological studies that focus on older adults with cognitive impairments have endured additional challenges ranging from increased vulnerability of this group to COVID-19, thereby prohibiting study participation, to difficulties in participant engagement as a product of a worsening Digital Divide. The purpose of this talk is to describe the pandemic-related factors that have influenced recruitment and enrollment of older adults with mild cognitive impairment and mild dementia in an ongoing feasibility study of a physical activity smartphone app. We discuss the changes we made to recruitment procedures and the impact those changes have had on the success of enrolling individuals in the study. We conclude with a discussion of feasible strategies and procedural alterations moving forward that may facilitate achievement of enrollment goals.

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Mesenchymal stromal cells for COVID-19: A living systematic review protocol

10.1101/2020.04.13.20064162 ◽

2020 ◽

Cited By ~ 1

Author(s):

Gabriel Rada ◽

Javiera Corbalán ◽

Patricio Rojas ◽

Keyword(s):

Systematic Review ◽

Mesenchymal Stromal Cells ◽

Stromal Cells ◽

Direct Evidence ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Central Register ◽

Randomised Trials ◽

Eligibility Criteria ◽

The Impact

ABSTRACTObjectiveTo determine the impact of mesenchymal stromal cells outcomes important to patients with COVID-19.DesignThis is the protocol of a living systematic review.Data sourcesWe will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal.Eligibility criteria for selecting studies and methodsWe adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question.We will include randomised trials evaluating the effect of mesenchymal stromal cells versus placebo or no treatment in patients with COVID-19. Randomised trials evaluating other coronavirus infections, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19 will be searched in case we find no direct evidence from randomised trials, or if the direct evidence provides low- or very low-certainty for critical outcomes.Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome.A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.Ethics and disseminationNo ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.PROSPERO RegistrationSubmitted to PROSPERO (awaiting ID allocation).

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