Communicating deprescribing decisions made in hospital with general practitioners in the community

Abstract

Background Deprescribing, the supervised withdrawal of inappropriate medications, intends to manage polypharmacy, which is prevalent in older patients. Aims To examine general practitioner (GP) perceptions of communication processes between clinicians in hospital and GP in the community about deprescribing decisions made in hospital. Methods Focus groups and interviews were held with 15 GP, exploring deprescribing in hospitals, communication of deprescribing information and the format of communications. Sessions were audiotaped, transcribed and analysed using an inductive approach. Results GP stated that they should be involved in deprescribing decisions, especially for older complex patients, because of their good knowledge of their patients. Barriers to effective communication included the acute nature of hospital stays and lack of time. Facilitators included long‐term relationships of GP with their patients and engaged patients. GP preferred communication of deprescribing decisions to be over the telephone while the patient was still in hospital, and with a concise, electronic discharge summary at the time of discharge. GP indicated that rationale for medication changes and recommended follow‐up actions were crucial in a discharge summary to enable care post‐discharge. Conclusions GP welcome increased communication with hospital clinicians regarding deprescribing decisions made while patients are in hospital. Communication needs to be timely, transparent, succinct and accessible. Lack of time and difficulties contacting hospital clinicians challenge this process.

Strategies to guide the successful implementation of deprescribing in community practice: Lessons learned from the front line

“…35 Improving interprofessional communication has been shown to increase prescriber acceptance of collaborative patient-centred deprescribing. 47,48 Patients see multiple health care providers often with little shared communication, resulting in fragmentation of care. 49 This can contribute to a repetitive cycle of prescribing and a challenge for deprescribing.…”

In‐hospital deprescribing in the real world – a clinician‐led approach to hyperpolypharmacy

“…Given the ongoing relationship between patients and their primary care providers, sustainable deprescribing can only be achieved with GP involvement. Nguyen et al 25 indicated that GPs value timely and comprehensive communication from hospital-based clinicians while their patients are still in hospital. Perhaps even more importantly, discharge summaries must be comprehensive and provide adequate information about the rationale for deprescribing to allow GPs to better understand and maintain these changes after discharge.…”

“…Given the ongoing relationship between patients and their primary care providers, sustainable deprescribing can only be achieved with GP involvement. Nguyen et al 25 . indicated that GPs value timely and comprehensive communication from hospital‐based clinicians while their patients are still in hospital.…”

Establishing the worth of deprescribing inappropriate medications: are we there yet?

“…Fragmented care: As patient care spans multiple clinical settings, disconnected information communication results in failure of propagation of, and adherence to, deprescribing decisions through the chain of multiple prescribers. 13 Changing illness trajectories: Deprescribing is not a one-off activity but needs to be repeated when changes occur in patients' clinical status that alter benefit-harm estimates for specific medications.…”

“…Fragmented care: As patient care spans multiple clinical settings, disconnected information communication results in failure of propagation of, and adherence to, deprescribing decisions through the chain of multiple prescribers. 13 …”