Isenor, Jennifer
Permanent URI for this collectionhttps://hdl.handle.net/10222/42829
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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 Impact of pharmacists as immunizers on vaccination rates: a systematic review and meta-analysis(2016) Isenor, JE; Edwards, NT; Alia, TA; Slayter, KL; MacDougall, DM; McNeil, SA; Bowles, SKBackground: Underutilization of vaccination programs remains a significant public health concern. Pharmacists serve as educators, facilitators, and in some jurisdictions, as administrators of vaccines. Though pharmacists have been involved with immunizations in various ways for many years, there has yet to be a systematic review assessing the impact of pharmacists as immunizers in these three roles. Objective: To complete a systematic review of the literature on the impact of pharmacists as educators, facilitators, and administrators of vaccines on immunization rates. Methods: We identified 2825 articles searching the following databases from inception until October 2015: PubMed, EMBASE, Cochrane Libraries, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Google Scholar. Grey literature was identified through use of the Canadian Agency for Drugs and Technology in Health “Grey Matters” search tool. Content from relevant journals and references of included studies were also searched. Inclusion criteria were clinical or epidemiologic studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms. Results: Thirty-six studies were included in the review, 22 assessed the role of pharmacists as educators and/or facilitators and 14 assessed their role as administrators of vaccines. All studies reviewed found an increase in vaccine coverage when pharmacists were involved in the immunization process, regardless of role (educator, facilitator, administrator) or vaccine administered (e.g., influenza, pneumococcal), when compared to vaccine provision by traditional providers without pharmacist involvement. Limitations of the results include the large number of non-randomized trials and the heterogeneity between study designs. Conclusions: Pharmacist involvement in immunization, whether as educators, facilitators, or administrators of vaccines, resulted in increased uptake of immunizations. PROSPERO Registration: CRD42013005067