Display options
Cite
Williams S, Louissaint J, Nikirk S, et al. Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors. United European Gastroenterol J. 2021;9(2):193-202doi: 10.1177/2050640620975224.
Williams, S., Louissaint, J., Nikirk, S., Bajaj, J. S., & Tapper, E. B. (2021). Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors. United European gastroenterology journal, 9(2), 193-202. https://doi.org/10.1177/2050640620975224
Williams, Sydni, et al. "Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors." United European gastroenterology journal vol. 9,2 (2021): 193-202. doi: https://doi.org/10.1177/2050640620975224
Williams S, Louissaint J, Nikirk S, Bajaj JS, Tapper EB. Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors. United European Gastroenterol J. 2021 Mar;9(2):193-202. doi: 10.1177/2050640620975224. Epub 2021 Feb 18. PMID: 33226300; PMCID: PMC8259255.
Copy Download .nbib Format: NLM
Share it on

United European Gastroenterol J. 2021 Mar;9(2):193-202. doi: 10.1177/2050640620975224. Epub 2021 Feb 18.

Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors.

United European gastroenterology journal

Sydni Williams, Jeremy Louissaint, Sam Nikirk, Jasmohan S Bajaj, Elliot B Tapper

Affiliations

  1. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
  2. Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, USA.
  3. Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.

PMID: 33226300 PMCID: PMC8259255 DOI: 10.1177/2050640620975224

Abstract

BACKGROUND AND AIMS: Multiple medications are associated with an increased risk of incident hepatic encephalopathy. Despite this known risk, medications such as opioids, benzodiazepines, gabapentin/pregabalin, and/or proton pump inhibitors are increasingly prescribed to persons with cirrhosis. Deprescribing is a promising intervention to reduce the burden of hepatic encephalopathy. Given that deprescribing has not been trialed in cirrhosis, we evaluated the barriers and facilitators to safe and successful deprescribing in cirrhosis.

METHODS: We conducted, transcribed, and analyzed semi-structured interviews using qualitative methodology with 22 subjects. This included eight patients with cirrhosis and recent use of opiates, benzodiazepines, gabapentin/Lyrica, and/or proton pump inhibitors as well as 14 providers (primary care, transplant surgery, transplant hepatology). Interviews explored opinions, behaviors, and understanding surrounding the risks and benefits of deprescribing.

RESULTS: Major provider-specific barriers included deferred responsibility of the deprescribing process, knowledge gaps regarding the risk of hepatic encephalopathy associated with medications (e.g., proton pump inhibitors) as well as the safe method of deprescription (i.e., benzodiazepines), and time constraints. Patient-specific barriers included knowledge gaps regarding the cirrhosis-specific risks of their medications and anxiety about the recurrence of symptoms after medication discontinuation. Patients uniformly reported trust in their provider's opinions on risks and wished for more comprehensive education during or after visits. Providers uniformly reported support for deprescription resources including pharmacist or nurse outreach.

CONCLUSION: Given knowledge of medication risks related to hepatic encephalopathy in patients with cirrhosis, deprescribing is universally seen as important. Knowledge gaps, inaction, and uncertainty regarding feasible alternatives prevent meaningful implementation of deprescription. Trials of protocolized pharmacy-based deprescribing outreach and patient-facing education on risks are warranted.

© 2020 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.

Keywords: benzodiazepines; hepatic encephalopathy; medication deprescribing; opiates

References

  1. Hepatology. 2018 Jun;67(6):2375-2383 - PubMed
  2. Hepatol Commun. 2019 Sep 06;3(11):1510-1519 - PubMed
  3. Hepatology. 2009 Oct;50(4):1175-83 - PubMed
  4. Am J Gastroenterol. 2018 Aug;113(8):1177-1186 - PubMed
  5. J Appl Meas. 2010;11(3):315-30 - PubMed
  6. J Clin Pharm Ther. 1995 Aug;20(4):199-205 - PubMed
  7. Aliment Pharmacol Ther. 2017 Jan;45(2):319-331 - PubMed
  8. Clin Transl Gastroenterol. 2017 Jul 27;8(7):e108 - PubMed
  9. N Engl J Med. 2016 Mar 17;374(11):1053-64 - PubMed
  10. Arch Phys Med Rehabil. 2011 Oct;92(10 Suppl):S52-60 - PubMed
  11. Arch Phys Med Rehabil. 2013 Sep;94(9):1721-30 - PubMed
  12. J Am Pharm Assoc (2003). 2020 Jan - Feb;60(1):100-104 - PubMed
  13. Ann Behav Med. 2007 Nov-Dec;34(3):304-12 - PubMed
  14. JAMA Intern Med. 2018 Dec 1;178(12):1673-1680 - PubMed
  15. Aliment Pharmacol Ther. 2020 Jun;51(12):1397-1405 - PubMed
  16. Eur J Clin Pharmacol. 2017 Aug;73(8):927-935 - PubMed
  17. J Health Psychol. 2013 Feb;18(2):212-25 - PubMed
  18. Clin Gastroenterol Hepatol. 2017 Aug;15(8):1271-1278.e6 - PubMed
  19. JAMA. 2018 Nov 13;320(18):1889-1898 - PubMed
  20. Clin Gastroenterol Hepatol. 2016 Aug;14(8):1181-1188.e2 - PubMed
  21. Hepatology. 1987 Jan-Feb;7(1):122-8 - PubMed
  22. Am J Gastroenterol. 2018 Nov;113(11):1600-1612 - PubMed

Publication Types

Grant support