Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study

BMJ Open, Journal Year: 2022, Volume and Issue: 12(3), P. e054279 - e054279

Published: March 1, 2022

Objective To explore the barriers/facilitators to deprescribing in primary care England from perspectives of clinicians, patients living with frailty who reside at home, and their informal carers, drawing on Theoretical Domains Framework identify behavioural components associated process. Design Exploratory qualitative study. Setting General practice (primary care) England. Participants 9 aged 65+ attended a consultation reduce or stop medicine/s. 3 carers frailty. 14 clinicians including general practitioners, pharmacists advanced nurse practitioners. Methods Qualitative semistructured interviews took place frailty, clinicians. Patients (n=9) (n=3) were interviewed two times: immediately after 5/6 weeks later. Clinicians (n=14) once. In total, 38 undertaken. analysis was applied manage analyse data. Results 6 themes facilitators barriers generated, respectively, each supported by between three subthemes. Identified included shared decision-making, gradual introduction topic, clear communication topic patient multidisciplinary working. constraints, patients' fear negative consequences inaccessible terminology information. Conclusions This paper offers timely insight into for within context As continues grow national international significance, it is important that future interventions acknowledge current experienced improve safety effectiveness

Language: Английский

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Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial

BMJ Open, Journal Year: 2024, Volume and Issue: 14(1), P. e075325 - e075325

Published: Jan. 1, 2024

Objective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) appropriateness of and (3) implementation prescribing recommendations generated by electronic decision support system tested ‘Optimising PharmacoTherapy In Multimorbid Elderly Primary CAre’ (OPTICA) trial. Design A longitudinal sub-study OPTICA trial, a cluster randomised controlled Setting Swiss primary care settings. Participants were aged ≥65 years, with ≥3 chronic conditions ≥5 regular recruited from 43 general practitioner (GP) practices. Exposures Patients’ was assessed using three questions ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire its concerns about stopping score. Measures/analyses Medication-related outcomes collected at 1 year follow-up. Aim outcome: number long-term baseline 12 month 2 medication (Medication Appropriateness Index). 3 binary variable on whether any recommendation during review implemented. We used multilevel linear regression analyses (aim aim 2) logistic 3). Models adjusted for sociodemographic variables clustering effect GP level. Results 298 patients completed rPATD, 45% women 78 years median age. statistically significant found score over time (per 1-unit increase average use 0.65 higher; 95% CI: 0.08 1.22). Other than that we did not find evidence associations agreement deprescribing medication-related outcomes. Conclusions an most measures patient year. Trial registration NCT03724539 .

Language: Английский

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A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial

BMC Health Services Research, Journal Year: 2019, Volume and Issue: 19(1)

Published: March 14, 2019

Polypharmacy is prevalent among hospitalized older adults, particularly those being discharged to a post-care care facility (PAC). The aim of this randomized controlled trial determine if patient-centered deprescribing intervention initiated in the hospital and continued PAC setting reduces total number medications patients. Shed-MEDS study 5-year, clinical comparing describing with usual (≥50 years) patients PAC, either skilled nursing (SNF) or an inpatient rehabilitation (IPR). Patient measurements occur at enrollment, discharge, within 7 days 60 90 following discharge. Patients are permuted block fashion, sizes two four. overall effectiveness will be evaluated using medication count as primary outcome measure. We estimate that 576 enroll study. Following attrition due death loss follow-up, 420 contribute days, which provides 90% power detect 30% versus 25% reduction alpha error 0.05. Secondary outcomes include associated geriatric syndromes, drug burden index, adherence, prevalence severity syndromes functional health status. aims test hypothesis continuing through stay reduce discharge result improvements results quantify reducing for adults polypharmacy who post-acute facilities. This was prospectively registered clinicaltrials.gov ( NCT02979353 ). first on 12/1/2016, update 09/28/17 10/12/2018.

Language: Английский

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Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study

Journal of the American Geriatrics Society, Journal Year: 2020, Volume and Issue: 68(4), P. 746 - 753

Published: Feb. 17, 2020

OBJECTIVES Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults, yet patients' and caregivers' perspectives on medication value how this affects their willingness discontinue a are poorly understood. We sought identify the most significant factors that impact perceived of from perspective patients caregivers. DESIGN Qualitative study using focus groups conducted September October 2018. SETTING Participants Pepper Geriatric Research Registry (patients) Pitt+Me (caregivers) maintained by University Pittsburgh. PARTICIPANTS Six community‐dwelling adults aged 65 years older, caregivers, prescribed five more preceding 12 months. MEASUREMENTS (1) general views what makes worth taking; (2) specific features such as cost side effects value; (3) reactions clinical scenarios related deprescribing. RESULTS identified four themes. Perceived effectiveness was primary factor caused participants consider be high value. considered low if it adversely affected quality life. also cited when determining value, especially resulted material sacrifices. valued providers with whom they had good relationships rather than valuing level training. When presented scenarios, ably weighed these indicated whether would adhere recommendation. CONCLUSION effectiveness, adverse life, cost, strong relationship prescriber influenced These findings will enable prescribers engage shared allow health systems incorporate patient‐centered assessment into systems‐based interventions. J Am Geriatr Soc 68:746–753, 2020

Language: Английский

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Attitudes of older adults and their carers towards de‐prescribing: A systematic review

Diabetic Medicine, Journal Year: 2022, Volume and Issue: 39(7)

Published: Feb. 4, 2022

Abstract Aim The aim of this systematic review is to explore the attitudes older adults (≥65 years old) and their carers towards de‐prescribing. Methods We identified relevant studies from three databases; MEDLINE, CINAHL Web Science. Two reviewers (MS, SS) independently extracted data each selected study using a standardised self‐developed extraction form. Main findings were summarised descriptively. Results A total 35 included in review. Of them, 19 questionnaire studies, 11 semi‐structured interviews, 4 focus groups 1 used nominal group technique approach. Most willing have medication de‐prescribed if told do so by healthcare professional (HCP). Other factors that increased willingness de‐prescribing included; trust HCP, side effects inconvenience medications as well prospect follow‐up monitoring during In contrast, perceived effectiveness, unawareness lack benefit, negative expectations ageing fear preventing Conclusion De‐prescribing an important concept people given harm associated with polypharmacy age group. Overall, are facilitated HCP. However, there remain few barriers which may need be addressed certain patients, through discussions between adults/their allow more effective.

Language: Английский

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Barriers and Enablers for Deprescribing Glucose-Lowering Treatment in Older Adults: A Systematic Review

Journal of the American Medical Directors Association, Journal Year: 2024, Volume and Issue: 25(3), P. 439 - 447.e18

Published: Jan. 15, 2024

Language: Английский

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Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study

Frontiers in Pharmacology, Journal Year: 2020, Volume and Issue: 11

Published: Aug. 20, 2020

Deprescribing has been recommended for managing polypharmacy but deprescribing preventive medication in older patients is still uncommon. We aimed to investigate patients' barriers and enablers of cardiometabolic medication.Two focus groups were conducted among ≥70 years with polypharmacy, including medication. Purposive sampling through four community pharmacies was used two regions the Netherlands. A topic list developed using literature theoretical domains framework (TDF). The meetings audio recorded, transcribed verbatim coded thematic coding, attribute coding TDF. In addition, categorized on attitudes towards willingness stop.The attended by 17 1 caregiver (71 84 years). total 15 13 identified within themes, partly related beliefs, fears experiences regarding or stopping medication, relationship health care professional conditions stop. Some attributed their wellbeing therefore unwilling Reducing because less strict treatment targets confused some a barrier deprescribing. Having options monitor clinical measurements restart enablers. Patients only willing stop when this proposed HCP they trusted. positive attitude varied negative generally perceived several may consider as being essential.Fears, well trust influence have deprescribed. Attitudes general do not necessarily translate into unwillingness specific For patient involvement setting new monitoring effects short-term outcomes are important.

Language: Английский

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Deprescribing: Moving beyond barriers and facilitators

Research in Social and Administrative Pharmacy, Journal Year: 2021, Volume and Issue: 18(3), P. 2547 - 2549

Published: April 19, 2021

Language: Английский

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Barriers and enablers of older adults initiating a deprescribing conversation

Patient Education and Counseling, Journal Year: 2021, Volume and Issue: 105(3), P. 615 - 624

Published: June 24, 2021

Language: Английский

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Predictors of older patients' willingness to have medications deprescribed: A cross‐sectional study

Basic & Clinical Pharmacology & Toxicology, Journal Year: 2023, Volume and Issue: 133(6), P. 703 - 717

Published: April 18, 2023

Deprescribing is a complex process requiring patient-centred approach. One frequently expressed deprescribing barrier patients' attitudes and beliefs towards deprescribing. This study aimed to identify the predictors of willingness have medications deprescribed.A cross-sectional was conducted with community-dwelling patients aged ≥65 who are taking at least one regular medication. Data collection included demographic clinical characteristics Portuguese revised Patients' Attitudes Towards (rPATD) questionnaire. Descriptive statistics were used present characteristics. Multiple binary logistic regression analysis performed deprescribed.One hundred ninety-two participants (median age 72 years; 65.6% female) included. Most (83.33%) willing deprescribed, (adjusted odds ratio [aOR] = 1.136; 95% CI 1.026, 1.258), female sex (aOR 3.036; 1.059, 8.708) rPATD concerns about stopping factor 0.391; 0.203, 0.754).Most their deprescribed if it recommended by doctors. Older increased deprescribe; higher decreased odds. These findings suggest that addressing medicines may contribute success.

Language: Английский

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