Deprescribing has recently been applied to address polypharmacy, particularly among older adults. However, the characteristics of deprescribing that are likely to improve health outcomes have not been well studied. This study explored the experiences and perspectives of general practitioners and pharmacists with regard to deprescribing in older adults with multimorbidity. A qualitative study was conducted involving eight semi-structured focus group interviews with 35 physicians and pharmacists from hospitals, clinics, and community pharmacies. Thematic analysis was applied to identify themes using the theory of planned behavior as a guide. The results illustrated a metacognitive process, as well as influencing factors, through which healthcare providers commit to shared decision making for deprescribing. Healthcare providers acted on the basis of their attitudes and beliefs on deprescribing, the influence of subjective norms, and perceived behavioral control for deprescribing. These processes are influenced by factors such as drug class, prescribers, patients, deprescribing experience, and environment/education. Healthcare providers’ attitudes, beliefs, and behavioral control (along with deprescribing strategies) evolve in a dynamic interplay with experience, environment, and education. Our results can serve as a foundation for the development of effective patient-centered deprescribing to improve the safety of pharmaceutical care for older adults.
Background: Studies have shown that a usual source of care increases the receipt of child preventive care; however, the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy has not been fully investigated.The aims of this study were to elucidate the characteristics of mothers with a primary care physician, and to explore the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy among mothers in Japan. Method:This cross-sectional survey-based study included 4516 mothers. Using a chisquare test, the characteristics of mothers with and without a primary care physician were compared. Poisson regression was applied to evaluate the relationship between having a usual source of primary care and parental COVID-19 vaccine hesitancy.Results: Mothers with a usual source of primary care had higher education, lower mental distress, had younger children, and were less hesitant toward the child's COVID-19 vaccination. Vaccine hesitancy was observed in 39.8% of mothers with a usual source of primary care and 45.5% of those without. Poisson regression analysis showed that mothers with a primary care physician were less vaccine-hesitant (IRR = 0.90, 95% CI = 0.84-0.96) after adjusting for potential confounders. Conclusion:This study suggested that having a usual source of primary care may contribute to lower parental COVID-19 vaccine hesitancy. However, the high vaccine hesitancy rate, even among mothers with a usual source of primary care, warrants healthcare providers to be equipped to help parents make informed decisions about vaccination through the continuity of care.
Background: Alcoholic liver cirrhosis is a life-threatening condition, especially in patients who are unable to reduce their alcohol use. Alcohol abuse is closely linked to low socioeconomic status and social marginalization. In Japan, public assistance (PA) or Seikatsu-hogo ensures medical care for low-income populations. This study aimed to investigate the potential excess mortality among patients with alcoholic cirrhosis who were recipients of PA. Methods: Patients diagnosed with alcoholic liver cirrhosis at a community hospital between 2006 and 2017 were included in this retrospective study. Baseline demographics and mortality data were extracted from the electronic health records. Cirrhosis severity at baseline was measured using the mean model for end-stage liver disease (MELD) and albumin-bilirubin (ALBI) scores. The primary outcome was the survival probability obtained using the Cox proportional hazards regression analysis. Results: A total of 244 participants were included, of which 62 were PA recipients. Baseline cirrhosis severity scores did not differ between the PA group and non-PA groups. The overall mortality rates were 48.4% and 31.9% for PA and non-PA recipients, respectively (p=0.002). In the Cox regression model adjusted for age, ALBI score, HCV infection, and presence or absence of a designated key family contact, the hazard ratio for PA status was 1.75 p=0.039]. Conclusions: Being a PA recipient is a poor prognostic factor for overall mortality in patients with alcoholic liver cirrhosis after adjusting for age, cirrhosis severity, and social support.
Background: Alcohol liver cirrhosis is a life-threatening condition, especially if alcohol cessation is not accomplished. Past studies have shown that alcohol abuse is closely linked to low socioeconomic status and social marginalization. Public assistance (PA), or Seikatsu-hogo, a Japanese public assistance ensuring medical care to low-income population, was employed as a proxy for social marginalization. This study aims to investigate the prognostic effect of being a PA recipient on overall mortality in patients with alcoholic cirrhosis.Methods: Patients diagnosed as alcoholic liver cirrhosis in a community hospital between 2006 to 2017 were included in this retrospective cohort study. Baseline demographics and mortality data were extracted from electronic health records. Cirrhosis severity at baseline was measured by mean model for end-stage liver disease (MELD) score and Albumin-Bilirubin (ALBI) score. Primary outcome was survival probability obtained by the Kapan Meier method and Cox proportional hazards regression. Results: 244 participants were included, among which 62 were PA recipients. Baseline cirrhosis severity score was not different between the two groups. Incidence proportion for overall mortality was 48.4% and 31.9% for PA recipients and non-PA recipients, respectively (p=0.002). In cox regression model, adjusted for age, ALBI score and HCV infection, hazard ratio for PA reception was1.57 (95% CI: 0.97-2.5, p=0.06). Conclusions: Being a PA recipient may be a poor prognostic factor of mortality in patients with alcoholic liver cirrhosis.
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