Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff

Lo, Sarita; Reeve, Emily; Page, Amy; Zaidi, Syed Tabish Razi; Hilmer, Sarah N.; Etherton‐Beer, Christopher; McLachlan, Andrew J.; Pont, Lisa G.; Naganathan, Vasi

doi:10.1007/s40266-021-00874-2

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…Education was identified by all HCPs as a strong potential deprescribing enabler, similar to other deprescribing studies in this setting [ 24 , 42 ]. Educational opportunities include continuing professional development courses and on-site training, both of which have shown to effectively reduce PIM use in older adults [ 43 ].…”

Section: Discussionsupporting

confidence: 71%

Barriers and enablers to deprescribing in long-term care: A qualitative investigation into the opinions of healthcare professionals in Ireland

et al. 2022

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Introduction The prevalence of polypharmacy increases with age, increasing the exposure of older adults to potentially inappropriate medications (PIMs). Deprescribing has been shown to reduce PIMs for older residents in long-term care; however, deprescribing is not universally implemented. This study aims to identify the barriers and enablers to deprescribing in Irish long-term care facilities from the healthcare professionals’ (HCPs) perspective. Methods A qualitative descriptive approach was conducted using semi-structured interviews with HCPs working in long-term care (general practitioners, pharmacists and nurses). Purposive sampling with maximum variation was applied to select long-term care sites to identify HCPs, supplemented with convenience sampling of post-graduate HCPs from University College Cork. Data was thematically analysed and mapped to a framework of deprescribing barriers and enablers informed by the Theoretical Domains Framework. Results Twenty-six HCPs participated from 13 long-term care facilities. The main barriers and enablers identified mapped to five domains. Barriers included insufficient resources, lack of co-ordination between healthcare settings and negative social influences. Additional barriers exist in private settings including deprescribing awareness, commitment and the need for incentives. Deprescribing enablers included interprofessional support and patient social influence. To encourage deprescribing, potential enablers include HCP education, pharmacist role expansion and tailored deprescribing guidelines within a structured process. Conclusion Interventions to support deprescribing should build on existing systems, involve stakeholders and utilise guidelines within a structured process. Any intervention must account for the nuanced barriers and enablers which exist in both public and private settings.

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Section: Discussionsupporting

confidence: 71%

Barriers and enablers to deprescribing in long-term care: A qualitative investigation into the opinions of healthcare professionals in Ireland

et al. 2022

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“…14 Aged care staff did not perceive their role extended to influencing prescribing decisions, expressing it was the GP’s role and a lack of confidence in challenging decision-making, consistent with previous Australian aged care surveys. 20 Addressing these knowledge and confidence gaps requires inclusive education and strategies to support attendance including flexible modes, and dedicated time and remuneration for completion.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care

Jokanovic,

Lee,

Haines

et al. 2023

Preprint

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ObjectiveTo evaluate the feasibility of a nurse-led antimicrobial stewardship (AMS) program in two Australian residential aged care homes (RACHs) to inform a stepped-wedged, cluster randomised controlled trial (SW-cRCT).MethodsA mixed-methods pilot study of a nurse-led AMS program was performed in two RACHs in Victoria, Australia between July and December 2019. The AMS program comprised education, infection assessment and management guidelines, and documentation to support appropriate antimicrobial use in urinary, lower respiratory and skin/soft tissue infections. The program was implemented over three phases over five months: 1) pre-implementation education and integration (1-month); 2) implementation of the intervention (3-months); 3) post-intervention evaluation (1-month). Baseline RACH and resident data and weekly infection and antimicrobial usage was collected. Feedback on intervention resources and implementation barriers were identified from semi-structured interviews, online staff questionnaire and researcher field notes.ResultsSix key barriers to implementation of the intervention were identified and used to refine the intervention; aged care staffing and capacity, access to education, resistance to practice change, role of staff in AMS, leadership and ownership of the intervention at the RACH and organisation-level, and expectations from family. A total 61 antimicrobials were prescribed for 40 residents over the 3-month intervention period. Overall, 48% of antibiotics did not meet the minimum criteria for appropriate initiation (respiratory 73%; urinary: 54%; skin/soft tissue: 0%).ConclusionsSeveral barriers and opportunities to improve the implementation of AMS in RACHs were identified. Findings were used to inform a revised intervention to be evaluated in a larger SW-cRCT.

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“…Provider-level factors associated with deprescribing include beliefs and/or attitudes about both prescribing (e.g., preventative medications, symptom management) and deprescribing (e.g., reluctance or fear of stopping medications) [73,[80][81][82][83][84]; clinical expertise, training, and experience with deprescribing [85]; knowledge about the patient, their preferences, and goals of care to inform deprescribing decisions [74,86]; and clinician time and resources to support collaboration among multiple providers to make deprescribing decisions [72]. Health-care system-level factors associated with deprescribing include clinical guidelines related to both prescribing and deprescribing practices, professional and provider culture about deprescribing [44], incomplete or inaccurate medication use information to inform deprescribing decisions, availability and feasibility of alternative treatments, reimbursement structure, and resources to support deprescribing and shared decision-making among multiple providers.…”

Section: Barriers and Enablers Of Deprescribingmentioning

confidence: 99%

“…Provider‐level factors associated with deprescribing include beliefs and/or attitudes about both prescribing (e.g., preventative medications, symptom management) and deprescribing (e.g., reluctance or fear of stopping medications) [73, 80–84]; clinical expertise, training, and experience with deprescribing [85]; knowledge about the patient, their preferences, and goals of care to inform deprescribing decisions [74, 86]; and clinician time and resources to support collaboration among multiple providers to make deprescribing decisions [72].…”

Section: Barriers and Enablers Of Deprescribingmentioning

confidence: 99%

Implementation considerations of deprescribing interventions: A scoping review

et al. 2023

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Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health‐care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health‐care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high‐risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health‐care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.

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Attitudes to Drug Use in Residential Aged Care Facilities: A Cross-Sectional Survey of Nurses and Care Staff

Cited by 11 publications

References 31 publications

Barriers and enablers to deprescribing in long-term care: A qualitative investigation into the opinions of healthcare professionals in Ireland

Barriers and enablers to deprescribing in long-term care: A qualitative investigation into the opinions of healthcare professionals in Ireland

Pilot study of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care

Implementation considerations of deprescribing interventions: A scoping review

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