Methodology for Developing Deprescribing Guidelines: Using Evidence and GRADE to Guide Recommendations for Deprescribing
Publication Date
August 12, 2016
Journal
PLOS ONE
Authors
Barbara Farrell, Kevin Pottie, Carlos H. Rojas Fernandez, Lise M. Bjerre, et al
Volume
11
Issue
8
Pages
e0161248
DOI
https://dx.plos.org/10.1371/journal.pone.0161248
Publisher URL
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0161248
Scopus
84983490232
Mendeley
http://www.mendeley.com/research/methodology-developing-deprescribing-guidelines-using-evidence-grade-guide-recommendations-deprescri
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Mendeley | Further Information

{"title"=>"Methodology for developing deprescribing guidelines: Using evidence and GRADE to guide recommendations for deprescribing", "type"=>"journal", "authors"=>[{"first_name"=>"Barbara", "last_name"=>"Farrell", "scopus_author_id"=>"7102597814"}, {"first_name"=>"Kevin", "last_name"=>"Pottie", "scopus_author_id"=>"6602828498"}, {"first_name"=>"Carlos H.", "last_name"=>"Rojas-Fernandez", "scopus_author_id"=>"6701824897"}, {"first_name"=>"Lise M.", "last_name"=>"Bjerre", "scopus_author_id"=>"6603222621"}, {"first_name"=>"Wade", "last_name"=>"Thompson", "scopus_author_id"=>"55901664600"}, {"first_name"=>"Vivian", "last_name"=>"Welch", "scopus_author_id"=>"7005816948"}], "year"=>2016, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84983490232", "pui"=>"611775373", "doi"=>"10.1371/journal.pone.0161248", "isbn"=>"19326203", "sgr"=>"84983490232", "pmid"=>"27517450"}, "id"=>"a25a600a-3502-38ee-9020-003019ed627b", "abstract"=>"Background: Class specific deprescribing guidelines could help clinicians taper and stop medications no longer needed or which may be causing more harm than benefit. We set out to develop methodology to create such guidelines using evidence-based methods for guideline development, evidence synthesis and recommendation rating. Methods and Findings: Using a comprehensive checklist for a successful guideline enterprise, we conducted a national modified Delphi consensus process to identify priorities for deprescribing guidelines, then conducted scoping exercises to identify feasible topics, and sequentially developed three deprescribing guidelines. We selected guideline development team members for clinical expertise; a GRADE member worked with staff to ensure guideline development processes were followed. We conducted or used systematic searches and reviews of deprescribing trials of selected drug classes, reviews or systematic reviews of drug class effectiveness, reviews of reviews of drug class harm and narrative syntheses of contextual questions to inform recommendations and guideline development. Our 8 step process for guideline development included defining scope and purpose, developing a logic model to guide the process and generate key clinical questions, setting criteria for admissible evidence and conducting systematic reviews, synthesizing evidence considering additional contextual information and performing quality estimates, formulating recommendations and providing strength estimations, adding clinical considerations, conducting clinical and stakeholder review and finally updating content pre-publication. Innovative aspects of the guideline development process included synthesizing evidence for outcomes of tapering or stopping medication, and incorporating evidence for medication harm into the recommendation strength rating. Through the development of three deprescribing guidelines (for proton pump inhibitors, benzodiazepine receptor agonists and antipsychotics) and associated decision-support algorithms, we were able to gradually hone the methodology; each guideline will be published separately. Conclusion: Our methodology demonstrates the importance of searching for short and long-term outcomes, showing the benefits of deprescribing and studying patient preferences. This publication will support development of future deprescribing guidelines.", "link"=>"http://www.mendeley.com/research/methodology-developing-deprescribing-guidelines-using-evidence-grade-guide-recommendations-deprescri", "reader_count"=>57, "reader_count_by_academic_status"=>{"Unspecified"=>7, "Professor > Associate Professor"=>2, "Librarian"=>3, "Researcher"=>11, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>2, "Other"=>4, "Student > Master"=>10, "Student > Bachelor"=>3, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>1, "Professor"=>3}, "reader_count_by_user_role"=>{"Unspecified"=>7, "Professor > Associate Professor"=>2, "Librarian"=>3, "Researcher"=>11, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>2, "Other"=>4, "Student > Master"=>10, "Student > Bachelor"=>3, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>1, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>14, "Nursing and Health Professions"=>5, "Medicine and Dentistry"=>21, "Arts and Humanities"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>10, "Sports and Recreations"=>1, "Psychology"=>1, "Social Sciences"=>2, "Computer Science"=>1, "Economics, Econometrics and Finance"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>21}, "Social Sciences"=>{"Social Sciences"=>2}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Psychology"=>{"Psychology"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>5}, "Unspecified"=>{"Unspecified"=>14}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>10}, "Arts and Humanities"=>{"Arts and Humanities"=>1}}, "reader_count_by_country"=>{"Spain"=>1}, "group_count"=>4}

Scopus | Further Information

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