Korenstein D, Harris RP, Elshaug AG, et al. J Gen Intern Med. 2021;36:2105-2110.
Provider and patient underestimation of harms of tests and treatments may lead to over treatment. This article presents seven domains of harm of tests and treatment which warrant comprehensive research: (1) physical impairment, (2) psychological distress, (3) social disruption, (4) disruption in connection to healthcare, (5) labeling, (6) financial impact, and (7) treatment burden. Research is especially important in vulnerable patient populations.
Bulliard J‐L, Beau A‐B, Njor S, et al. Int J Cancer. 2021;149:846-853.
Overdiagnosis of breast cancer and the resulting overtreatment can cause physical, emotional, and financial harm to patients. Analysis of observational data and modelling indicates overdiagnosis accounts for less than 10% of invasive breast cancer in patients aged 50-69. Understanding rates of overdiagnosis can assist in ascertaining the net benefit of breast cancer screening.
Shafiee Hanjani L, Hubbard RE, Freeman CR, et al. Intern Med J. 2021;51:520-532.
Cognitively impaired older adults living in residential aged care facilities (RACF) are at risk of adverse drug events related to potentially inappropriate polypharmacy. Based on telehealth visits with 720 RACF residents, 66% were receiving polypharmacy, with cognitively intact residents receiving significantly more medications than cognitively impaired residents. Overall, 82% of residents were receiving anti-cholinergic medications which should be avoided in this population. Future interventions and research should pay particular attention to the prescribing of these medications.
Overuse of healthcare services can result in financial, physical, and emotional harm to the patient. If patients and clinicians better understood the risk of potential harms due to overuse, preventable harms may be reduced. Research is needed to quantify harm resulting from overuse of healthcare services, including the number of patients harmed and how serious the harms are.
Jørgensen IF, Brunak S. NPJ Digital Med. 2021;4(1):12.
Overdiagnosis is a growing area of concern within patient safety. The authors present a generalizable approach for identifying patients at risk of being mis- or overdiagnosed. Using chronic obstructive pulmonary disease (COPD) patients as an example, the authors outline how to create significant, temporal disease trajectories, and compare similarities between these disease trajectories and individual patient disease histories to identify the cases that may signal overdiagnosis.
Bloomfield HE, Greer N, Linsky AM, et al. J Gen Intern Med. 2020;35:3323-3332.
Deprescribing is one strategy to reduce polypharmacy among older adults. This systematic review found that medication deprescribing interventions (particularly those involving comprehensive medication review) may provide small reductions in mortality and use of potentially inappropriate medications among community-dwelling older adults.
Balsom C, Pittman N, King R, et al. Int J Clin Pharm. 2020:Epub Jun 3.
Polypharmacy is one risk factor for medication errors in older adults. This study describes the implementation of a pharmacist-administered deprescribing program in a long-term care facility in Canada. Over a one-year period, residents were randomized to receive either a deprescribing-focused medication review by a pharmacist or usual care. The intervention resulted in fewer medications taken by residents the intervention group after 6 months. Most deprescribing recommendations reflected a lack of ongoing indication or a dosage that was too high.
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