Whelan, Anne Marie
Permanent URI for this collectionhttps://hdl.handle.net/10222/42833
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Item Open Access Deprescribing Interventions in Primary Health Care Mapped to the Behaviour Change Wheel: A Scoping Review(Elsevier, 2021-07) Isenor, JE; Bai, I; Cormier, R; Helwig, Melissa; Reeve, Emily; Whelan, Anne Marie; Burgess, Sarah; Martin-Misener, Ruth; Kennie-Kaulbach, NatalieBackground: Polypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review. Objective: This scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW). Methods: A scoping review was conducted that involved searches of six databases (2002 to 2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT). Results: Searches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion. Conclusions: Deprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care.Item Open Access Key Priorities to Implement Deprescribing in Primary Health Care in Nova Scotia: Results from the Deprescribing in Primary Health Care in Nova Scotia Knowledge Exchange Event (June 20, 2019)(2020-03-03) Isenor, Jennifer; Kennie-Kaulbach, Natalie; Kehoe, Sarah; Bai, Isaac; Reeve, Emily; Whelan, Anne Marie; Burgess, Sarah; Kits, Olga; Burge, Frederick; Martin-Misener, Ruth; Helwig, Melissa; Sampalli, TaraInappropriate medication use and polypharmacy are associated with increased adverse drug reactions, hospitalizations and mortality. Deprescribing has been found to decrease the use of medications and medication costs and is expected to improve clinical outcomes. An interactive in-person knowledge exchange event using World Café and Nominal Group Technique was held with stakeholders including patient advisors, representatives from nursing, pharmacy, family medicine, and members of advocacy/regulatory bodies and government/policy representatives. Six themes were identified with accompanying key priorities that need to be addressed to implement deprescribing strategies in Nova Scotia. These included: Communication (including public awareness and communication between providers and patients, families and caregivers), Compensation (for all providers), Education (for the public and providers), Prompts (electronic and social), Resources (technology supports and resources) and Roles (providers, patients, families and caregivers). The key priorities will be shared with stakeholders to help inform future sustainable deprescribing strategies in Nova Scotia.Item Open Access Formation of a Collaborative Interprofessional Primary Healthcare Deprescribing Research Team in Nova Scotia(2019-06) Whelan, Anne Marie; Kennie-Kaulbach, Natalie; Isenor, Jennifer; Martin-Misener, Ruth; Burge, Fred; Burgess, Sarah; Reeve, Emily; Salsbury, Lauren E.; Cormier, Rachel; Bai, Isaac; MacLean, Heather; Helwig, Melissa; Kits, OlgaStudy objective: To describe the development of a collaborative interprofessional primary health care deprescribing research team in Nova Scotia. Methods: Initiated by two College of Pharmacy faculty members, a core group of 6 health care researchers with an interest in forming an interprofessional primary health care deprescribing research team met in 2016. Based on positive feedback, the next steps involved building the team which included 1) creating the team (determination of needed expertise; description of roles and responsibilities); 2) establishing goals/objectives; 3) determining team functioning (leadership, ascertainment of common mission, determining communication strategies and delineating decision-making approaches); and 4) monitoring team outputs (e.g. presentations, publications, grants); and team functioning (e.g. discussions at team meetings, team assessment survey, social network analysis). Results: The first team meeting was in April 2017, and as of January 2019 the team had expanded to 9 core members with research assistants/students added to the team as necessary. At initial team meetings, the two College of Pharmacy faculty members assumed a co-leadership role, established the overarching goal of the team, set specific objectives and reached a consensus on various aspects of team functioning. The team has received five grants. Eight posters/oral presentations have been presented and two manuscripts are in preparation. A team assessment survey was completed in the spring of 2018 which resulted in changes to communication strategies. A social network analysis is underway. Conclusions: An interprofessional deprescribing primary health care research team was successfully formed in Nova Scotia. This success has hinged on a team committed to working well together, sharing common goals, effective communication, positivity towards the research and celebrating successes.Item Open Access Evaluating the quality of randomized controlled trials that examine the efficacy of natural health products: a systematic review of critical appraisal instruments(2009-12) Whelan, A. M.; Jurgens, T. M.; Lord, L.The purpose of this project was to conduct a systematic review to identify instruments designed to evaluate the quality of randomized controlled trials (RCTs) of natural health products (NHPs). Instruments were examined for inclusion of items assessing methods, identity and content of the NHP, generalizability of results and instructions for use. Online databases, websites, textbooks and reference lists were searched to identify instruments. Relevance assessment and data extraction of articles were completed by two investigators and disagreements were settled by the third investigator. Data were analyzed using descriptive statistics. Of the 4442 citations identified, 29 were potentially relevant with 16 meeting the criteria for inclusion. None of the instruments stated they were validated; content in the four areas of interest varied considerably. The most common items included randomization sequence generation (100%), blinding (100%), allocation concealment (75%) and participant flow (75%). Only nine of the NHP instruments included at least one item to appraise the specific content of the NHP. The CONSORT Statement for Herbal Interventions most closely addressed the four areas of interest; however, this instrument was specific for herbs. There is a need for the development of a validated instrument for assessment of the quality of RCTs that would be useful for herbs as well as other NHPs.