Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care

Sinnige, J.; Korevaar, Joke C.; Lieshout, Jan van; Westert, Gert P.; Schellevis, François G.; Braspenning, Jozé

doi:10.3399/bjgp16x685681

Cited by 31 publications

(77 citation statements)

References 38 publications

(39 reference statements)

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“…General practitioners generally felt that this positioned them as the gatekeepers or coordinators of their older patients' care . However, this perception was contradicted by another recurrent dialogue where GPs noted that the hierarchy between themselves and their specialist counterparts prevented them from questioning medication prescribing decisions, even if it meant continuing medications with no clear indications or that were potentially inappropriate …”

Section: Resultsmentioning

confidence: 99%

“…Both older adults and their GPs thought that there was not enough time during consultations to review medications, consider patient preferences, and determine the priorities patients valued . Furthermore, GPs were not adequately reimbursed for more complex consultations, especially with patients with multiple morbidities, including undertaking medication reviews, and deprescribing discussions and follow‐up .…”

Section: Resultsmentioning

confidence: 99%

“…Changes in practice were suggested, including the ability to consult with pharmacists, inviting fellow GPs to conduct independent prescribing reviews, phone consults with geriatricians and/or specialists, and referrals to services able to provide nonpharmacological options . However, it is notable that the GPs in the study by Sinnige et al only sought help when their patient's condition did not improve. The use of information technology applications designed to monitor and support prescribing was met with some caution.…”

Section: Resultsmentioning

confidence: 99%

“…The use of information technology applications designed to monitor and support prescribing was met with some caution. These were regarded as not well suited to prescribing in the context of the complex needs of the individual older patient with multiple morbidities …”

Section: Resultsmentioning

confidence: 99%

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Deprescribing medications for older adults in the primary care context: A mixed studies review

Gillespie

Harrison

Mullan

2018

Health Science Reports

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Aims: This review investigates the factors that influence deprescribing of medications in primary care from the perspective of general practitioners (GPs) and community-living older adults. Methods:A mixed studies review structure was adopted searching Scopus, CINAHL, PsychINFO, ProQuest, and PubMed from January 2000 to December 2017. A manual search of reference lists was also conducted. Studies were included if they were original research available in English and explored general deprescribing rather than deprescribing of a specific class of medications. The Mixed Methods Assessment Tool was used to assess the quality of studies, and content analysis generated common categories across studies.Results: Thirty-eight articles were included, and 7 key categories were identified.The review found that the factors that influence deprescribing are similar across and within health systems and mostly act as barriers. These factors remained unchanged across the review period. The structural organisation of health systems remains poorly suited to facilitate deprescribing. Individual knowledge gaps of both GPs and older adults influence practices and attitudes towards deprescribing, and significant communication gaps occur between GPs and specialists and between GPs and older adults. As a result, deprescribing decision making is characterised by uncertainty, and deprescribing is often considered only when medication problems have already arisen. Trust plays a complex role, acting as both a barrier and facilitator of deprescribing. towards reducing polypharmacy (including deprescribing), from the perspective of both community-living older adults and GPs. This is important because, as mentioned earlier, deprescribing is most often considered in the context of the treatment of older adults. ConclusionsThe purpose of the current review is to build on Bokhof and JuniusWalker 24 work by investigating the factors that influence deprescribing from the perspective of both GPs and adults aged 65 years or older.Independent, community-living older adults are the focus of this review, as the majority of this group retain autonomy and are capable of being responsible for their own health decisions, 17 hence the importance of considering deprescribing from their perspective. Given the increasing evidence that is now available on this topic, a review that incorporates all study types is warranted. Interventions to promote deprescribing will require change on the part of both prescribers and older adults, so it is important to consider how their views interact to create the context where deprescribing discussions can take place. | METHODSA mixed studies review methodology was used as a guide to explore the factors that influence deprescribing. 27,282.1 | Eligibility criteria | Inclusion criteriaFull text primary research articles were included that were available in English, published between January 2000 and December 2017, and that investigated deprescribing or medication cessation/discontinuation in the primary care context for ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Deprescribing medications for older adults in the primary care context: A mixed studies review

Gillespie

Harrison

Mullan

2018

Health Science Reports

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“…While countries such as the Netherlands have a long tradition of GP–pharmacist IPE activities [23,24], these are not common in Australia, based on advertised educational activities both in the RACGP and ACP websites and also in comments we received from our participants. Because of the plethora of CPD activities offered to GPs, usually sponsored by pharmaceutical companies, GPs are accustomed to attending symposia and workshops where they earn CPD points to meet their respective college requirements.…”

Section: Discussionmentioning

confidence: 99%

Learnings and challenges to deploy an interprofessional and independent medical education programme to a new audience

Driel

McGuire

Stark

et al. 2017

Journal of European CME

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The importance of interprofessional education (IPE) in continuing medical education and professional development has long been recognised by health organisations and academic societies, benefiting not only patient outcomes and interprofessional relationships but also overall health systems and workforce shortage. We report on the outcomes of an Australian IPE activity on medication-overuse headache (MOH) with general practitioners (GPs) and community pharmacists as learners. The design of the activity, which followed the predisposing–enabling–reinforcing instructional framework by Green and Kreuter, aimed to: (1) improve knowledge and foster a willingness in GPs and pharmacists to work collaboratively to enhance the prevention, diagnosis and management of MOH; and (2) address their educational gap by demonstrating the utility of a blended learning IPE strategy on MOH. Integrated into the activity was an assessment of its effectiveness and impact to instil change in the participants’ knowledge of MOH, attitude and willingness to treat, and clinical practice behaviours of GPs and pharmacists to work together. The learners gained knowledge and confidence in diagnosing and managing MOH and in their ability to educate patients. The IPE approach suited the activity and was valued by the participating GPs and pharmacists, who seldom experience such learning formats. However, for educational providers in Australia, developing and deploying an independent medical education (IME) programme can be challenging. Providers of IMEs need to be aware of the potential pitfalls when competing with pharmaceutical-company-sponsored and delivered programmes.

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Barriers to appropriate prescribing in older adults with multimorbidity: A modified Delphi study

et al. 2021

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Potentially inappropriate prescribing (PIP) in older adults is a rising concern around the world, as life expectancies are increasing and people are living longer with multimorbidity. 1 Inappropriate prescribing can be partly attributed to polypharmacy, which is commonly defined as taking five or more medications daily. 2 Although there is variability in the definition of polypharmacy in the literature, polypharmacy is unavoidable among older adults as they are more likely to have comorbid or multimorbid conditions. Polypharmacy increases the risk of one being prescribed inappropriate medications with risks outweighing their benefits, which could result in adverse drug events, drug interactions, decline in functional status, cognitive impairment, falls, urinary incontinence, and reduced nutritional status. 3 A systematic review on the prevalence of potentially inappropriate medication use in older inpatients with or without cognitive impairment found the range to be from 0.6% to 88.5% when using clinical tools such as Beers criteria and Screening Tool of Older Persons' Prescriptions (STOPP). 4 With trends in polypharmacy and PIP expected to continue rising among older adults, 1,5 it is crucial to

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Medication management strategy for older people with polypharmacy in general practice: a qualitative study on prescribing behaviour in primary care

Cited by 31 publications

References 38 publications

Deprescribing medications for older adults in the primary care context: A mixed studies review

Deprescribing medications for older adults in the primary care context: A mixed studies review

Learnings and challenges to deploy an interprofessional and independent medical education programme to a new audience

Barriers to appropriate prescribing in older adults with multimorbidity: A modified Delphi study

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