Older Adults’ Perceptions of the Causes and Consequences of Healthcare Overuse: A Qualitative Study

Green, Ariel R.; Tung, Monica; Segal, Jodi B

doi:10.1007/s11606-017-4264-y

Cited by 14 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings build on prior studies by characterizing patients' and caregivers' perspectives on medication value with a greater degree of granularity. Consistent with prior studies, we demonstrate that perceived benefit is the primary reason a patient would wish to continue taking a medication and that side effects would make a patient consider a medication not worth taking. We further identified specific factors related to inconvenience or discomfort, such as frequency of administration and associated testing, which could be helpful to prescribers when identifying medications that a patient would be willing to discontinue.…”

Section: Discussionsupporting

confidence: 87%

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

Pickering

Hamm

Dawdani

et al. 2020

J American Geriatrics Society

View full text Add to dashboard Cite

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

show abstract

Section: Discussionsupporting

confidence: 87%

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

Pickering

Hamm

Dawdani

et al. 2020

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…We applaud the recent findings by Green et al and their recommendations regarding possible interventions to address patient perceptions of overuse. 1 We agree that improving patient engagement by integrating shared decision making is a potential solution, but we suggest that an approach of tackling both overuse and underuse concurrently is needed as well.…”

Section: Etter To the Editormentioning

confidence: 89%

Older Adults’ Perceptions of Healthcare Overuse

2018

View full text Add to dashboard Cite

“…21 26 Interestingly, there is also evidence that older adults perceived overuse to have occurred when interventions were used in the absence of symptoms (excluding cancer screening) did not improve symptoms, or against their preferences. 27 AF screening devices have been found to be well accepted by participants in previous large-scale trials. 28 29 However, many participants in our study stated they would be happy to undergo prolonged screening only if recommended by their doctor and some participants had specific concerns with respect to the time taken.…”

Section: Open Accessmentioning

confidence: 96%

Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

et al. 2020

View full text Add to dashboard Cite

ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

show abstract

Older Adults’ Perceptions of the Causes and Consequences of Healthcare Overuse: A Qualitative Study

Abstract: The experience of older adults highlights potential sites of intervention to reduce healthcare overuse. Engaging patients in shared decision making and enhancing communication and knowledge transfer should be tested as interventions to reduce perceived overuse.

Cited by 14 publications

References 23 publications

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

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

Older Adults’ Perceptions of Healthcare Overuse

Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

Contact Info

Product

Resources

About