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Article ; Online: Comment on: "Patient Perceptions of Opioids and Benzodiazepines and Attitudes Toward Deprescribing".

Langford, Aili V / Schneider, Carl R / Reeve, Emily / Doctor, Jason N / Gnjidic, Danijela

2024 Volume 41, Issue 1, Page(s) 77–78

MeSH term(s)	Humans ; Benzodiazepines/adverse effects ; Deprescriptions ; Analgesics, Opioid/adverse effects ; Health Knowledge, Attitudes, Practice
Chemical Substances	Benzodiazepines (12794-10-4) ; Analgesics, Opioid
Language	English
Publishing date	2024-01-02
Publishing country	New Zealand
Document type	Letter ; Comment
ZDB-ID	1075770-3
ISSN	1179-1969 ; 1170-229X
ISSN (online)	1179-1969
ISSN	1170-229X
DOI	10.1007/s40266-023-01086-6
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Article ; Online: Survey content validation evaluating the dissemination and implementation of deprescribing guidelines.

Cheng, Chun Hei Justin / Langford, Aili V / Gnjidic, Danijela / Farrell, Barbara J / Schneider, Carl R

Basic & clinical pharmacology & toxicology

2023 Volume 134, Issue 1, Page(s) 63–71

Abstract: Background: Policies, protocols and processes within organisations can facilitate or hinder guideline adoption. There is limited knowledge on the strategies used by organisations to disseminate and implement evidence-based deprescribing guidelines or ... ...

Abstract	Background: Policies, protocols and processes within organisations can facilitate or hinder guideline adoption. There is limited knowledge on the strategies used by organisations to disseminate and implement evidence-based deprescribing guidelines or their impact. Methods: We aimed to develop an online survey targeting key organisations involved in deprescribing guideline endorsement, dissemination, modification or translation internationally. Survey questions were drafted, mirroring the six components of the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. Content validation was undertaken and established by a panel of clinicians, researchers and implementation experts. Results: A 52-item survey underwent two rounds of content validation. The minimum threshold (I-CVI > 0.78) for relevance and importance was met for 39 items (75%) in the first round and 44 of 48 items (92%) in the second round. The expert panel concluded that the adoption, implementation and effectiveness survey sections were largely relevant and important to this topic, whereas the reach and maintenance sections were harder to understand and may be less pertinent to the research question. Conclusions: A 44-item survey investigating dissemination and implementation strategies for deprescribing guidelines has been developed and its content validated. Widespread survey distribution may identify effective strategies and inform dissemination and implementation planning for newly developed guidelines.
MeSH term(s)	Deprescriptions ; Surveys and Questionnaires
Language	English
Publishing date	2023-07-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2134679-3
ISSN	1742-7843 ; 1742-7835
ISSN (online)	1742-7843
ISSN	1742-7835
DOI	10.1111/bcpt.13922
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Article ; Online: Can we improve patient outcomes through using evidence-based opioid deprescribing guidelines to reduce opioid use?

Langford, Aili V / Schneider, Carl R / Lin, Chung-Wei Christine / Gnjidic, Danijela

Pain

2021 Volume 163, Issue 2, Page(s) e382

MeSH term(s)	Analgesics, Opioid/therapeutic use ; Deprescriptions ; Humans ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/prevention & control
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-11-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1097/j.pain.0000000000002371
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Article ; Online: Patient-targeted interventions for opioid deprescribing: An overview of systematic reviews.

Langford, Aili V / Schneider, Carl R / Lin, Chung-Wei Christine / Bero, Lisa / Collins, Jack C / Suckling, Benita / Gnjidic, Danijela

Basic & clinical pharmacology & toxicology

2023 Volume 133, Issue 6, Page(s) 623–639

Abstract: Background: Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals.: Objective: To synthesize and evaluate evidence from systematic reviews examining the effectiveness and ... ...

Abstract	Background: Deprescribing (reduction or cessation) of prescribed opioids can be challenging for both patients and healthcare professionals. Objective: To synthesize and evaluate evidence from systematic reviews examining the effectiveness and outcomes of patient-targeted opioid deprescribing interventions for all types of pain. Methods: Systematic searches were conducted in five databases with results screened against predetermined inclusion/exclusion criteria. Primary outcomes were (i) reduction in opioid dose, reported as change in oral Morphine Equivalent Daily Dose (oMEDD) and (ii) success of opioid deprescribing, reported as the proportion of the sample for which opioid use declined. Secondary outcomes included pain severity, physical function, quality of life and adverse events. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Findings: Twelve reviews were eligible for inclusion. Interventions were heterogeneous in nature and included pharmacological (n = 4), physical (n = 3), procedural (n = 3), psychological or behavioural (n = 3) and mixed (n = 5) interventions. Multidisciplinary care programmes appeared to be the most effective intervention for opioid deprescribing; however, the certainty of evidence was low, with significant variability in opioid reduction across interventions. Conclusions: Evidence is too uncertain to draw firm conclusions about specific populations who may derive the greatest benefit from opioid deprescribing, warranting further investigation.
MeSH term(s)	Humans ; Analgesics, Opioid/adverse effects ; Quality of Life ; Deprescriptions ; Systematic Reviews as Topic ; Pain/drug therapy ; Pain/chemically induced
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-02-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2134679-3
ISSN	1742-7843 ; 1742-7835
ISSN (online)	1742-7843
ISSN	1742-7835
DOI	10.1111/bcpt.13844
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Article ; Online: Measuring the impact of system level strategies on psychotropic medicine use in aged care facilities: A scoping review.

Langford, Aili V / Chen, Timothy F / Roberts, Chris / Schneider, Carl R

Research in social & administrative pharmacy : RSAP

2019 Volume 16, Issue 6, Page(s) 746–759

Abstract: Background: Psychotropic medication use in the elderly population is associated with significant adverse effects. Robust evidence for the efficacy of psychotropic medications for behavioural and psychological symptoms of dementia is lacking. Despite ... ...

Abstract	Background: Psychotropic medication use in the elderly population is associated with significant adverse effects. Robust evidence for the efficacy of psychotropic medications for behavioural and psychological symptoms of dementia is lacking. Despite national bodies, governments, and policymakers employing interventions to optimise the use of psychotropic medicines in this population, there is little research on their overall impact. Objective: To identify and categorise system level strategies that have been implemented internationally and assess their impact on psychotropic medicine use in aged care facilities. Methods: A systematic search of health-related databases including Medline, Embase, CINAHL, Web of Science and Scopus was performed. Empirical studies published in English prior to March 2019 that reported on the impact of system level strategies on psychotropic medicine use in aged care facilities were included. Studies were mapped to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to measure impact and were assessed for risk of bias. Results: This review identified 36 studies which examined mandatory (n = 22) and non-mandatory (n = 14) system level strategies. The impact of strategies was highly dependent on implementation as well as organisational and patient factors. Mandatory strategies had greater evidence of impact on drug utilisation patterns compared to non-mandatory strategies which primarily focussed on adoption and implementation, rather than outcomes. The Omnibus Budget Reconciliation Act 1987 (OBRA-87) in the United States of America had the greatest reach and implementation of the interventions examined, with an observed reduction in psychotropic medicine use post-implementation. There was no substantive body of evidence reporting on the sustainability of strategies or the influence of cost on outcomes. Conclusions: Despite the implementation of system level strategies, psychotropic medicine use in aged care facilities remains problematic. There is a need for revised or novel system level strategies which consider sustainability, economic influences and patient outcomes in their design and implementation.
MeSH term(s)	Aged ; Drug Utilization ; Humans ; Psychotropic Drugs/therapeutic use ; United States
Chemical Substances	Psychotropic Drugs
Language	English
Publishing date	2019-08-20
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2019.08.035
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Article ; Online: Nurses', Pharmacists' and Family Physicians' Perceptions of Psychotropic Medication Monitoring in Australian Long-Term Care Facilities: A Qualitative Framework Analysis.

Langford, Aili V / Ngo, Garzee Tracy / Chen, Timothy F / Roberts, Chris / Schneider, Carl R

Drugs & aging

2020 Volume 38, Issue 2, Page(s) 169–179

Abstract: Background: Current evidence suggests that despite modest benefit in using targeted psychotropic medications in the geriatric population, there is significant iatrogenic morbidity and mortality. Monitoring of the use of psychotropic medications by ... ...

Abstract	Background: Current evidence suggests that despite modest benefit in using targeted psychotropic medications in the geriatric population, there is significant iatrogenic morbidity and mortality. Monitoring of the use of psychotropic medications by health care professionals (HCPs) to reduce adverse effects is often suboptimal; however, there have been few theoretically informed studies as to why this is so. Objective: This study aimed to elucidate facilitators and barriers to psychotropic medication monitoring in long-term care facilities (LTCFs) from the viewpoint of nurses, pharmacists and family physicians. Secondly, it intended to identify targets for tailored intervention strategies to improve monitoring practices. Methods: A purposive sample of 31 HCPs working in LTCFs in Sydney, New South Wales, Australia was recruited. Three cohorts consisted of twelve registered nurses, ten pharmacists and nine family physicians. Semi-structured interviews were conducted, assessing perceptions of psychotropic medication monitoring in LTCFs, facilitators, barriers and proposed solutions. Interviews were transcribed verbatim and thematically analyzed through an inductive coding approach. Themes were then mapped to Ferlie and Shortell's 'Four Levels of Change' framework for improving quality in healthcare. Results: Monitoring was revealed as a multi-faceted concept, influenced by factors across individual, group, organization and system levels. Thematic analysis revealed six key themes pertinent to psychotropic monitoring in LTCFs: (1) engagement with monitoring, (2) monitoring capability, (3) opportunity to monitor, (4) roles and responsibilities, (5) communication and collaboration and (6) guidance and regulation. HCPs conceptualized monitoring differently, but consistently felt that monitoring in LTCFs was suboptimal, recognizing a need for guidance and resources to aid collaborative monitoring of psychotropic medications. HCPs internally situated within LTCFs (nurses) viewed psychotropic medication monitoring as a dynamic and ongoing phenomenon, occurring both formally and informally on a day-to-day basis. In contrast, externally situated HCPs (pharmacists and family physicians) typically associated medication monitoring with structured medication reviews and conceptualized monitoring as an intermittent and planned activity. Conclusions and implications: Psychotropic monitoring is perceived by all HCPs as a shared responsibility; however, the conceptualization of monitoring differs between HCPs. HCPs' beliefs and attitudes require consideration when designing implementation strategies for interventions to ameliorate suboptimal monitoring practices.
MeSH term(s)	Aged ; Australia ; Humans ; Long-Term Care ; Nurses ; Perception ; Pharmacists ; Physicians, Family
Language	English
Publishing date	2020-12-14
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	1075770-3
ISSN	1179-1969 ; 1170-229X
ISSN (online)	1179-1969
ISSN	1170-229X
DOI	10.1007/s40266-020-00825-3
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Article ; Online: "The lesser of two evils": a framework analysis of consumers' perspectives on opioid deprescribing and the development of opioid deprescribing guidelines.

Langford, Aili V / Gnjidic, Danijela / Lin, Chung-Wei Christine / Bero, Lisa / Blyth, Fiona / Penm, Jonathan / Schneider, Carl R

Pain

2021 Volume 162, Issue 11, Page(s) 2686–2692

Abstract: Abstract: Deprescribing opioids has been identified as an intervention to mitigate opioid harm; however, it is often challenging to implement interventions and communicate deprescribing decisions to consumers. The development of opioid deprescribing ... ...

Abstract	Abstract: Deprescribing opioids has been identified as an intervention to mitigate opioid harm; however, it is often challenging to implement interventions and communicate deprescribing decisions to consumers. The development of opioid deprescribing guidelines may provide guidance and support on when and how to reduce or cease opioids in routine care. This study aimed to explore the perspectives of opioid consumers on opioid deprescribing and determine factors to be considered in the development of opioid deprescribing guidelines. A purposive sample of 20 consumers using opioids for pain was recruited. Semistructured interviews were conducted, audio recorded, and transcribed verbatim. Inductive thematic analysis was undertaken, followed by a framework analysis informed by Bandura's Social Cognitive Theory. Behavioral, cognitive, and environmental factors influence consumers' attitudes and actions regarding opioid deprescribing. Significant barriers to opioid deprescribing were identified, including fears of pain and withdrawal effects, opioid-related stigma, and perceived inadequacies of the healthcare system. Improved communication between healthcare professionals and consumers regarding expectations of deprescribing and goals of care, as well as the provision of greater opportunities for consumer engagement in decision making were identified as avenues to improve the success of opioid deprescribing. For opioid deprescribing guidelines to be effective and achieve the intended goal of optimizing opioid use, consumers need to feel empowered to engage in opioid reduction or cessation. The findings of this study may facilitate a patient-centred approach for practitioners and guideline developers in creating recommendations and interventions to enable opioid deprescribing through targeting behavioral change.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Deprescriptions ; Humans
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-03-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1097/j.pain.0000000000002270
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Article ; Online: Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care.

Langford, Aili V / Bero, Lisa / Lin, Chung-Wei Christine / Blyth, Fiona M / Doctor, Jason N / Holliday, Simon / Jeon, Yun-Hee / Moullin, Joanna C / Murnion, Bridin / Nielsen, Suzanne / Penm, Jonathan / Reeve, Emily / Reid, Sharon / Wale, Janet / Osman, Rawa / Gnjidic, Danijela / Schneider, Carl R

Journal of clinical epidemiology

2023 Volume 165, Page(s) 111204

Abstract: Objectives: To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics.: Study design and setting: Evidence ... ...

Abstract	Objectives: To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics. Study design and setting: Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience. Results: The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four 'conditional' recommendations. Conclusion: The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
MeSH term(s)	Humans ; Evidence-Based Medicine ; Analgesics, Opioid/therapeutic use ; Deprescriptions ; Point-of-Care Systems ; Systematic Reviews as Topic
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-11-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	639306-8
ISSN	1878-5921 ; 0895-4356
ISSN (online)	1878-5921
ISSN	0895-4356
DOI	10.1016/j.jclinepi.2023.10.020
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Article ; Online: Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations.

Langford, Aili V / Lin, Christine Cw / Bero, Lisa / Blyth, Fiona M / Doctor, Jason / Holliday, Simon / Jeon, Yun-Hee / Moullin, Joanna / Murnion, Bridin / Nielsen, Suzanne / Osman, Rawa / Penm, Jonathan / Reeve, Emily / Reid, Sharon / Wale, Janet / Schneider, Carl R / Gnjidic, Danijela

The Medical journal of Australia

2023 Volume 219, Issue 2, Page(s) 80–89

Abstract: Introduction: Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical ... ...

Abstract	Introduction: Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. Main recommendations: Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid-related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care. Changes in management as a result of these guidelines: To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.
MeSH term(s)	Adult ; Humans ; Analgesics, Opioid/adverse effects ; Chronic Pain/drug therapy ; Deprescriptions ; Opioid-Related Disorders/drug therapy ; Quality of Life
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-06-25
Publishing country	Australia
Document type	Practice Guideline ; Research Support, Non-U.S. Gov't ; Journal Article
ZDB-ID	186082-3
ISSN	1326-5377 ; 0025-729X
ISSN (online)	1326-5377
ISSN	0025-729X
DOI	10.5694/mja2.52002
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Article ; Online: Challenges of opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines: a qualitative analysis.

Langford, Aili V / Gnjidic, Danijela / Lin, Chung-Wei Christine / Bero, Lisa / Penm, Jonathan / Blyth, Fiona M / Schneider, Carl R

BMJ quality & safety

2020 Volume 30, Issue 2, Page(s) 133–140

Abstract: Background: Chronic prescription opioid use is a major international public health issue associated with significant harms, including increased risk of hospitalisation, morbidity and death. Guidance for healthcare professionals on when and how to ... ...

Abstract	Background: Chronic prescription opioid use is a major international public health issue associated with significant harms, including increased risk of hospitalisation, morbidity and death. Guidance for healthcare professionals on when and how to deprescribe or reduce opioids is required. A key step for guideline development for deprescribing pharmacotherapy is to understand the perspectives of stakeholders. The aim of this study was to explore the perspectives of healthcare professional stakeholders on the challenges associated with opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines. Methods: A qualitative study was undertaken with a purposive sample of healthcare professionals including prescribers, pharmacists and nurses. An initial cohort of participants was identified at the 2018 Australian Deprescribing Network annual meeting and two focus groups were conducted (n=20). Individual interviews were conducted with a further 11 healthcare professionals. Focus groups and interviews were audio-recorded and transcribed verbatim. Data underwent inductive thematic analysis using a phenomenological perspective. Results: Healthcare professionals viewed opioid deprescribing as a challenge and identified several key barriers to deprescribing in clinical practice. Medication, patient, prescriber and health system level challenges were identified. Participants requested evidence-based guidance on the withdrawal of opioid therapies and suggested that prospective opioid deprescribing guidelines require a multitarget, multimodal intervention strategy that addresses patient psychosocial factors and incorporates behavioural change techniques. Conclusion: Opioid deprescribing was perceived as a complex and challenging practice with continued prescribing the default behaviour. Evidence-based opioid deprescribing guidelines may be a valuable resource for clinicians to support clinical decision-making and reduce suboptimal opioid use.
MeSH term(s)	Analgesics, Opioid ; Attitude of Health Personnel ; Australia ; Deprescriptions ; Humans ; Prospective Studies
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2020-03-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2592909-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2020-010881
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