A scoping review of polypharmacy interventions in patients with stroke, heart disease and diabetes.

Background Patients with cardiometabolic disease, specifically, stroke, heart disease and diabetes have a high prevalence of polypharmacy. Interventions to better manage or reduce polypharmacy in these populations may help improve patient outcomes. However, there is a paucity of data in this area, which needs to be investigated. Aim of the review The purpose of this scoping review was to identify and synthesize the available evidence pertaining to polypharmacy interventions in patients with cardiometabolic disease(s) and to determine what outcomes measures are assessed in these studies. Methods We followed an evidence-based scoping review guiding framework to address our study objectives. Three electronic databases (MEDLINE, EMBASE, CINAHL) were searched for all relevant studies up to May 2019. The Cochrane Library was also searched; studies included in relevant reviews were screened for inclusion. Reference lists of all included papers were also manually reviewed to identify additional articles. Polypharmacy interventions and measures used to assess efficacy were qualitatively described. Results Overall, six studies met the inclusion criteria. The majority of interventions were clinical pharmacist interventions reporting on a variety of outcomes including surrogate markers, quality of life and patient satisfaction, drug-related problems, and healthcare utilization and costs. The findings from the included studies generally indicated positive effects but had high risk of bias. Conclusions Existing polypharmacy interventions have some efficacy at improving a variety of patient and healthcare system outcomes. Increased frequency and duration of follow-up with patients led to significant improvements in quality of life, disease control and cost-savings in outpatient and in-patient settings. However, our analysis of the identified studies suggests low-quality evidence and significant knowledge gaps regarding patients with stroke and cardiometabolic multimorbidity. This signals a need for further high-quality research to both confirm these findings and include these other high-risk patient populations to validate these findings.

Palliative and end-of-life care education in Canadian emergency medicine residency programs: A national cross-sectional survey.

OBJECTIVES: Emergency physicians play an important role in providing care at the end-of-life as well as identifying patients who may benefit from a palliative approach. Several studies have shown that emergency medicine (EM) residents desire further training in palliative care. We performed a national cross-sectional survey of EM program directors. Our primary objective was to describe the number of Canadian postgraduate EM training programs with palliative and end-of-life care curricula. METHODS: A 15-question survey in English and French was sent by email to all program directors of both the Canadian College of Family Physicians emergency medicine (CCFP(EM)) and the Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) postgraduate training programs countrywide using FluidSurveys™ with a modified Dillman approach. RESULTS: We received a total of 26 responses from the 36 (response rate = 72.2%) EM postgraduate programs in Canada. Ten out of 26 (38.5%) programs had a structured educational program pertaining to palliative and end-of-life care. Lectures or seminars were the exclusive choice to teach content. Clinical palliative medicine rotations were mandatory in one out of 26 (3.8%) programs. The top two barriers to implementation of palliative and end-of-life care curricula were lack of time (84.6%) and curriculum development concerns (80.8%). CONCLUSIONS: Palliative and end-of-life care training within EM has been identified as an area of need. This cross-sectional survey demonstrates that a minority of Canadian EM programs have palliative and end-of-life care curricula. It will be important for all EM training programs, RCPSC-EM and CCFP(EM), in Canada, to develop an agreed upon set of competencies and to structure their curricula around them.