“Starting to think that way from the start”: approaching deprescribing decision-making for people accessing palliative care - a qualitative exploration of healthcare professionals views
BMC Palliative Care,
Journal Year:
2024,
Volume and Issue:
23(1)
Published: Sept. 6, 2024
Language: Английский
Factors influencing healthcare providers’ behaviours in deprescribing: a cross-sectional study
Journal of Pharmaceutical Policy and Practice,
Journal Year:
2024,
Volume and Issue:
17(1)
Published: Sept. 16, 2024
Deprescribing
serves
as
a
pivotal
measure
to
mitigate
the
drug-related
problem
due
polypharmacy.
This
study
aimed
map
factors
influencing
healthcare
providers'
deprescribing
decision
using
Behaviour
Change
Wheel
framework
and
develop
an
innovative
conceptual
model
support
practice.
A
cross-sectional
online
survey
targeting
doctors
pharmacists
was
conducted
assess
influence
of
various
on
comfort
in
recommending
deprescribing.
The
formulated,
based
existing
Wheel.
model's
robustness
scrutinised
through
Partial
Least
Squares
Structural
Equation
Modeling
(PLS-SEM),
model-fitting
indices
were
employed
obtain
best-fit
model.
total
736
responses
analysed
with
final
consisting
24
items
5
constructs
(R
2:
0.163;
SRMR:
0.064;
rho_c:
0.750-0.862;
AVE:
0.509-0.627)
three
independent
factors.
Based
results,
we
proposed
that
could
be
promoted
strategies
at
enhancing
providers
internal
capabilities
such
knowledge
levels,
when
patients'
condition
deteriorated
previous
experiences
adverse
events
drugs.
Organisational
providing
educational
opportunities
is
important,
empowerment
patient
policy
enhancements,
guideline
development,
effective
communication.
behaviours
professionals
are
influenced
by
intricate
interplay
patient,
prescriber,
system
Enhancing
practices
necessitates
comprehensive
strategy
encompasses
education,
development
structured
guidelines,
implementation
tools,
enhancement
communication
between
providers.
Language: Английский
A-I-D for cascades: an application of the Behaviour Change Wheel to design a theory-based intervention for addressing prescribing cascades in primary care
Implementation Science Communications,
Journal Year:
2024,
Volume and Issue:
5(1)
Published: Dec. 5, 2024
Abstract
Background
Prescribing
cascades,
which
occur
when
a
medication
is
used
to
treat
the
side
effect
of
another
medication,
are
important
contributors
polypharmacy.
There
an
absence
studies
that
evaluate
interventions
address
them.
We
describe
application
Behaviour
Change
Wheel
(BCW)
design
theory-informed
for
addressing
prescribing
cascades
within
interprofessional
primary
care
teams.
Methods
The
BCW
framework
was
applied
guide
intervention
development.
This
report
describes
first
seven
steps.
Three
behaviours
were
developed
based
on
data
collected
from
two
qualitative
exploring
why
and
how
across
practice
settings.
A
target
behaviour
selected
COM-B
model
identify
relevant
factors
Relevant
types,
policy
options,
corresponding
change
techniques
(BCTs)
identified,
examples
drafted.
Prioritization
guided
by
APEASE
criteria.
Results
three
involved
supporting:
(1)
healthcare
providers
(HCPs)
ask
about,
investigate
manage
(2)
public
about
(3)
share
histories
experiences
with
HCPs.
team
HCP
behaviour,
A-I-D
(ask,
investigate,
deprescribe),
Psychological
capability
physical
opportunity
most
components.
Ten
options
comprised
BCTs
developed,
ready
further
prioritization
stakeholders.
These
can
be
grouped
into:
provision
educational
materials
use
HCPs;
consultation
or
training
support
knowledge
mobilization
strategies.
Through
process,
identified
development
guidance
tool,
assists
HCPs
needed
Conclusions
practicing
in
teams
cascades.
When
identifying
future
consultation,
creation
tool
prioritized
as
it
underpins
all
proposed
practice.
Further
research
determine
what
would
need
this
will
practice,
its
Language: Английский
“Starting to think that way from the start": Approaching deprescribing decision-making for people accessing palliative care - a qualitative exploration of healthcare professionals views.
Research Square (Research Square),
Journal Year:
2024,
Volume and Issue:
unknown
Published: March 26, 2024
Abstract
Background:
Deprescribing
has
been
defined
as
the
planned
process
of
reducing
or
stopping
medications
that
may
no
longer
be
beneficial
are
causing
harm,
with
goal
medication
burden
while
improving
patient
quality
life.
At
present,
little
is
known
about
specific
challenges
decision-making
to
support
deprescribing
for
patients
who
accessing
palliative
care.
By
exploring
perspectives
healthcare
professionals,
this
qualitative
study
aimed
address
gap,
and
explore
of,
potential
solutions
to,
making
decisions
in
a
care
context.
Methods:
Semi-structured
interviews
were
conducted
professionals
in-person
via
video
call,
between
August
–
January
2023.
Perspectives
on
approaches
care;
when
how
they
might
deprescribe;
role
carers
family
members
within
discussed.
Interviews
audio-recorded
transcribed
verbatim.
Reflexive
thematic
analysis
enabled
development
themes.
QSR
NVivo
(Version
12)
facilitated
data
management.
Ethical
approval
was
obtained
from
NHS
Health
Research
Authority
(ref
305394).
Results:
Twenty
interviewed,
including:
medical
consultants,
nurses,
specialist
pharmacists,
general
practitioners
(GPs).
Participants
described
importance
decision-making,
it
should
considered,
proactive,
process.
Three
themes
developed
data,
which
centred
on:
(1)
professional
attitudes,
competency
responsibility
towards
deprescribing;
(2)
changing
culture
(3)
involving
family/caregivers
decision-making.
Conclusions:
This
sought
people
services.
A
range
identified
supporting
deprescribing,
so
becomes
proactive
patient’s
journey,
rather
than
reactive
consequence.
Future
work
their
can
best
supported
shared
processes
deprescribing.
Trial
registration:
Language: Английский
Did the COVID-19 pandemic affect medicine-related support for people living with HIV in the United Kingdom? – a cross-sectional survey
International Journal of Pharmacy Practice,
Journal Year:
2024,
Volume and Issue:
32(Supplement_1), P. i17 - i18
Published: April 1, 2024
Abstract
Introduction
In
2019,
there
were
105,200
people
living
with
HIV
(PLWH)
in
the
UK,
most
of
whom
(98%)
engaged
care
and
on
antiretroviral
medicines
(ARVs).
Globally,
COVID-19
pandemic
was
predicted
to
interrupt
continuum.[1]
England,
early
phases
revealed
a
shift
online,
or
remote
service
delivery
decline
sexual
health
provision
generally.[2]
Aim
To
investigate
PLWH’s
perceptions
effects
their
medicine-related
support
(MRS).
Methods
Institutional
ethics
approval
obtained
promote
an
online
survey
(1/09/2021
31/01/2023)
among
UK
residents.
Eligible
participants
PLWH,
aged
18
years
over,
using
ARVs
≥1
non-ARV.
Snowball
sampling
used
recruit
via
social
media.
The
asked
report
sources
whether
they
experienced
changes
how
during
pandemic.
An
open-ended
question
also
allow
any
other
issues
link
shared
HIV-related
charities
memberships.
Descriptive
statistics
thematic
analysis
for
quantitative
free-text
quotes
respectively.
Results
One
hundred
seventy-three
who
eligible
consented.
Ninety-five
provided
quotes.
mean
age
48.7
(SD±12.5)
50.5%
(n=51/101)
≥50
years.
majority
male
(77.5%,
n=79/102),
white
(86.1%,
n=87/101),
gay/lesbian
(60.8%,
n=62/102),
whilst
52.9%
employed
(n=54/102).
Approximately
1
5
(16%,
n=8/50)
younger
PLWH
reported
MRS,
9.8%
(n=5/51)
older
50+,
felt
MRS
changed.
Source
MRS:
Most
continued
use
specialist
healthcare
professionals
perceived
no
change
its
availability
due
COVID-19.
Within
primary
services,
more
general
practitioner
compared
community
pharmacist
(12.5%,
n=17/136
2.9%,
n=4/136,
respectively).
Frequency
appointments
around
person-centred
care:
Some
that
had
received
attention
from
others
noted
after
first
lockdown
fewer,
busier
staff
led
less
service.
Mode
Whilst
clinics
moved
appointments,
many
this
as
desirable
particularly
those
preferred
convenience
concerned
about
leaving
home
being
categorised
highest-risk
patient
groups.
Ten
stated
that,
COVID-19,
now
get
delivered
homes
instead
collecting
them
previously
local
pharmacy
clinic.
participant
wrote
“I
longer
periods
between
blood
tests
telephone
consultations.
I
prefer
face
face”,
another
52-year-old
female
stating
“Personally,
don’t
ever
want
replace
again”.
Access
medicines:
Only
8
(8.4%,
n=8/95)
accessed
medicines.
Two
interruptions
treatment;
shortage
medication.
When
phoned
my
hospital
ask
new
prescription,
couldn’t
give
me
one
unless
came
physically.
This
impossible
few
months
lockdown”
(male,
30).
Conclusion
While
did
not
perceive
pandemic,
minority
treatment
by
UK-wide
survey.
Patient
preferences
should
be
considered
when
delivering
consultations
PLWH.
Future
research
is
needed
explore
clinicians’
perspectives
ensure
continuity
crises.
References
1.
Jiang
H,
Zhou
Y,
Tang
W.
Maintaining
Lancet
2020;
7
(5):
E308-E309
2.
Mitchell
HD
et
al.
Effects
response
sexually
transmitted
infections,
HIV,
viral
hepatitis,
England.
Emerg
Infect
Dis
2022;28(3):739
Language: Английский