What Is Known About Preventing, Detecting, and Reversing Prescribing Cascades: A Scoping Review

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 66; no. 11; pp. 2079 - 2085
• Main Authors: Brath, Hana, Mehta, Nishila, Savage, Rachel D., Gill, Sudeep S., Wu, Wei, Bronskill, Susan E., Zhu, Lynn, Gurwitz, Jerry H., Rochon, Paula A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-11-2018
• Subjects: Anticholinergics; Case reports; Data processing; Inflammatory bowel diseases; Intestine; medication safety; older adult; Older people; prescribing cascade; scoping review; older adult; medication safety; prescribing cascade; scoping review
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.15543

OBJECTIVES
To systematically describe the resources available on preventing, detecting, and reversing prescribing cascades using a scoping review methodology.
MEASUREMENTS
We searched Medline, EMBASE, PsychINFO, CINAHL, Cochrane Library, and Sociological s from inception until July 2017. Other searches (Google Scholar, hand searches) and expert consultations were performed for resources examining how to prevent, detect, or reverse prescribing cascades. We used these three categories along the prescribing continuum as an organizing framework to categorize and synthesize resources.
RESULTS
Of 369 resources identified, 58 met inclusion criteria; 29 of these were categorized as preventing, 20 as detecting, and 9 as reversing prescribing cascades. Resources originated from 14 countries and mostly focused on older adults. The goal of preventing resources was to educate and increase general awareness of the concept of prescribing cascades as a way to prevent inappropriate prescribing and to illustrate application of the concept to specific drugs (e.g., anticholinergics) and conditions (e.g., inflammatory bowel disease). Detecting resources included original investigations or case reports that identified prescribing cascades using health administrative data, patient cohorts, and novel sources such as social media. Reversing prescribing cascade resources focused on the medication review process and deprescribing initiatives.
CONCLUSION
Prescribing cascades are a recognized problem internationally. By learning from the range of resources to prevent, detect, and reverse prescribing cascades, this review contributes to improving drug prescribing, especially in older adults. J Am Geriatr Soc 66:2079–2085, 2018.