Person-Centred Care Including Deprescribing for Older People

Smith, Heather; Miller, Karen; Barnett, Nina; Oboh, Lelly; Jones, Emyr; Darcy, Carmel M.; McKee, Hilary; Agnew, Jayne; Crawford, Paula

doi:10.3390/pharmacy7030101

Cited by 14 publications

(8 citation statements)

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“…This might be overcome by focusing on high-risk patients (e.g. frail patients), reviewing one medication at a time, and/or using every patient visit as an opportunity to review medication [ 46 , 47 ]. Involving other team members such as clinical pharmacists or nurses, especially for tasks like medication reconciliation and patient education, might make deprescribing more feasible [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF)

et al. 2022

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Background Falls can lead to hospitalisation and death in older people. Polypharmacy is a major risk factor, and deprescribing fall-risk increasing drugs (FRIDs) is one of several possible important preventive measures. The objective of this study was to explore the factors that influence doctors when deprescribing FRIDs in a hospital setting. Method Semi-structured interviews were conducted with consultant geriatricians and hospital doctors experienced in dealing with patients aged 65 years or older, at a large academic teaching hospital (~ 1000 beds), Dublin, Ireland. The interviews were directed by an interview guide and audio recorded and transcribed verbatim, with subsequent thematic analysis in NVivo 12 software. Results A total of 18 participants were interviewed. Barriers to deprescribing included: insufficient time, incomplete patient records, changing medications initiated by other specialists and difficulties following up patients after discharge. Facilitators included: enhanced documentation through electronic patient records, the support of other healthcare professionals such as clinical pharmacists, and patients’ engagement, which is considered essential for the success of the deprescribing process’s outcome. Conclusion Deprescribing FRIDs in older adults in the hospital setting is challenging. Implementation of the process in practice requires combined effort from stakeholders to tackle everyday work environment challenges. Future studies are required examining the clinical effect of the suggested interventions and exploring patients' involvement in deprescribing decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00985-4.

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Section: Discussionmentioning

confidence: 99%

Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF)

et al. 2022

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“…These strategies are likely to be more effective if delivered using a patient-centered approach. 40 It is important that treating physicians understand patient's preferences and goals of care, and how they can contribute to improving clinical outcomes through goal-directed medication reviews.…”

Section: Implementation Solutions: Patient Healthcare Professional and Healthcare Systemmentioning

confidence: 99%

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice. Deprescribing is an established management strategy to minimize polypharmacy and potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on the success of deprescribing interventions in research and practice. Management strategies that target all levels of the healthcare system are required to overcome these challenges. Future studies may consider large multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on clinical outcomes.

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“…If undertaken appropriately, deprescribing has been shown to support a reduction in ADRs and can improve quality of life. 3 Several process tools to support deprescribing have been created. 2 4–6 However, to date, no implementation science frameworks exist specific to deprescribing.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study

et al. 2022

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ObjectiveTo explore the barriers/facilitators to deprescribing in primary care in England from the perspectives of clinicians, patients living with frailty who reside at home, and their informal carers, drawing on the Theoretical Domains Framework to identify behavioural components associated with barriers/facilitators of the process.DesignExploratory qualitative study.SettingGeneral practice (primary care) in England.Participants9 patients aged 65+ living with frailty who attended a consultation to reduce or stop a medicine/s. 3 informal carers of patients living with frailty. 14 primary care clinicians including general practitioners, practice pharmacists and advanced nurse practitioners.MethodsQualitative semistructured interviews took place with patients living with frailty, their informal carers and clinicians. Patients (n=9) and informal carers (n=3) were interviewed two times: immediately after deprescribing and 5/6 weeks later. Clinicians (n=14) were interviewed once. In total, 38 interviews were undertaken. Framework analysis was applied to manage and analyse the data.Results6 themes associated with facilitators and barriers to deprescribing were generated, respectively, with each supported by between two and three subthemes. Identified facilitators of deprescribing with patients living with frailty included shared decision-making, gradual introduction of the topic, clear communication of the topic to the patient and multidisciplinary working. Identified barriers of deprescribing included consultation constraints, patients' fear of negative consequences and inaccessible terminology and information.ConclusionsThis paper offers timely insight into the barriers and facilitators to deprescribing for patients living with frailty within the context of primary care in England. As deprescribing continues to grow in national and international significance, it is important that future deprescribing interventions acknowledge the current barriers and facilitators and their associated behavioural components experienced by clinicians, patients living with frailty and their informal carers to improve the safety and effectiveness of the process.

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Person-Centred Care Including Deprescribing for Older People

Cited by 14 publications

References 30 publications

Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF)

Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF)

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study

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