Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review.

Polypharmacy, commonly defined as ≥5 medications, is a rising public health concern due to its many risks of harm. One commonly recommended strategy to address polypharmacy is medication reviews, with subsequent deprescription of inappropriate medications. In this review, we explore the intersection of older age, polypharmacy, and deprescribing in a contemporary context by appraising the published literature (2012-2022) to identify articles that included new primary data on deprescribing medications in patients aged ≥65 years currently taking ≥5 medications. We found 31 articles were found which describe the current perceptions of clinicians towards deprescribing, the identified barriers, key enabling factors, and future directions in approaching deprescribing. Currently, clinicians believe that deprescribing is a complex process, and despite the majority of clinicians reporting feeling comfortable in deprescribing, fewer engage with this process regularly. Common barriers cited include a lack of knowledge and training around the deprescribing process, a lack of time, a breakdown in communication, perceived 'abandonment of care', fear of adverse consequences, and resistance from patients and/or their carers. Common enabling factors of deprescribing include recognition of key opportunities to instigate this process, regular medication reviews, improving lines of communication, education of both patients and clinicians and a multidisciplinary approach towards patient care. Addressing polypharmacy requires a nuanced approach in a generally complex group of patients. Key strategies to reducing the risks of polypharmacy include education of patients and clinicians, in addition to improving communication between healthcare providers in a multidisciplinary approach.

Polypharmacy in older patients presenting to a tertiary regional health service: identifying correlations between demographics, presentations and length of stay.

This study aimed to describe hospital admissions in patients experiencing polypharmacy and evaluate the effects of demographic factors on length of stay (LOS) and polypharmacy. We found that increasing age is associated with increasing polypharmacy rates but decreasing LOS. Females were more likely to experience higher rates of polypharmacy, but males were more likely to have longer LOS. First Nations peoples had higher rates of polypharmacy and longer LOS. Future projects investigating deprescribing methods are critical.

Do educational interventions improve prescribing skills of medical students compared to no additional learning? A systematic review.

Research suggests that medical students are not confident and may be ill-prepared to prescribe competently. Therefore, changes to standard education may be required to fortify medical student prescribing skills, confidence, and competence. However, specific education to write a safe and legal prescription is generally lacking. Furthermore, the term prescribe and the skill thereof is not clearly defined. This review compares additional education for medical students to no identified additional education or another educational modality on the skill of prescription writing. Secondary aims include review of education modalities, prescribing skill assessments, educator professional background, and timing of education within the medical curriculum. This systematic review was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases searched included: CINAHL, Cochrane Library, EMBASE, Emcare (Ovid), MEDLINE (Ovid), PubMed and Scopus. Search terms included: medical education, medical undergraduate, medical student, medical school, and prescriptions. The search was conducted in February 2023, and quantitative outcomes were reported. Of the 5197 citations identified, 12 met the inclusion criteria. Eleven studies reported significant improvements in prescribing skills of medical students after additional educational intervention(s). Various educational modalities were implemented, including case-based teaching (n=3), patient-based teaching (n=1), tutorial-based teaching (n=2), didactic teaching (n=1), and mixed methods (n=6). There were no commonalities in the professional background of the educator; however, five studies used faculty members. There was no consensus on the best assessment type and time to implement prescription writing education during medical training. There are a range of interventions to educate and assess prescribing competencies of medical students. Despite heterogenous study designs, there is evidence of the superiority of additional prescription writing education versus no identified additional education to develop prescription writing skills. The introduction of formal teaching and standardised assessment of prescribing skills for medical students is recommended.

Pharmacist-Led Education for Final Year Medical Students: A Pilot Study.

Background: Prescribing is a core skillset for medical officers. Prescribing errors or deficiencies can lead to patient harm and increased healthcare costs. There is an undefined role for pharmacist-led education to final year medical students to improve prescribing skills. Aim: Assess if pharmacist-led education on prescription writing improves the quality and safety of final year medical students' prescribing skills. Method:  Participants and Intervention: Final year medical students were randomised into tutorial (TG) or non-tutorial groups (NTG) and assessed pre- and post- intervention. TG received education by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional training as per usual practice. Following the pre-test, all students completed a 3-week tertiary hospital medical ward placement. Students completed the post-test following placement and after the TG participated in the intervention. Student Assessment: Assessment included writing Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions. Results: At baseline, there were no significant differences between TG and NTG for overall scores or proportion of passes. Post intervention scores significantly improved in TG (p = 0.012) whereas scores significantly decreased in the NTG (p = 0.004). The overall proportion of passes was significantly higher in the TG than NTG (p < 0.001). Conclusion: Education by a clinical pharmacist improved short-term prescribing skills of final year medical students in this study. Students learning primarily experientially from peers and rotational supervisors showed decreased prescribing skills. We propose pharmacist-led education on prescription writing should be further evaluated in larger studies across more student cohorts and for longer periods of follow up time to clarify whether such an educational model could be included in future medical school curricula.