Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial.

BACKGROUND: Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient's priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults. METHODS: We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. DISCUSSION: Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient's goals and priorities for treatment. TRIAL REGISTRATION: Clinical Trials.gov NCT02942927. First registered on October 24, 2016.

Disappearing Acts: Anguish, Isolation, and the Re-imagining of the Mentally Ill in Global Psychopharmaceutical Advertising (1953-2005).

The visualization of mental illness has attracted substantial attention from scholars in recent decades. Due to the invisible nature of mental disorders, this work has stressed the importance of representations in shaping perceptions of mental illness. In the second half of the 20th century, advertisements for psychopharmaceutical medications became important avenues through which mental illness was made visible. This article analyzes how drug advertisements portrayed mentally ill individuals in medical journal advertisements from 14 countries between 1953 and 2005. We argue that a shift in representations occurred in the 1980s: whereas earlier campaigns were dominated by images of the mentally ill suffering in isolation, the post-1980s period was marked by a trend toward "positive" imagery, social inclusion, and ordinariness. This shift re-imagines the role of psychopharmaceuticals and who might be understood as mentally ill, reflecting changes in global marketing and the arrival of the "happiness turn" within the pharmaceutical industry.