Primary care clinician and community pharmacist perceptions of deprescribing

Huffmyer, Mark; Keck, James W.; Harrington, Nancy Grant; Freeman, Patricia R.; Westling, Matthew; Lukacena, Kaylee M.; Moga, Daniela C.

doi:10.1111/jgs.17092

Cited by 11 publications

(32 citation statements)

References 8 publications

(12 reference statements)

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“…Similarly, our survey of primary care clinicians and pharmacists identified communication, as well as trust within the clinician–patient–pharmacist triad, as important to the deprescribing process. 17 Although we did not specifically include questions related to trust within the clinician–patient–pharmacist triad in the patient survey, the survey did investigate patients’ perceptions of communication with primary care clinicians and pharmacists in further detail. We learned that, whereas most of our participants reported some level of communication with their primary care clinicians, one in five reported never communicating with a pharmacist about the medications they were taking.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of facilitating conversations is also supported by our finding that patients who reported effective communication with primary care clinicians and pharmacists had greater willingness to accept deprescribing if their clinicians said it was possible, whereas patients reporting higher concerns about stopping their medications had lower willingness to accept deprescribing. Because communication plays such a central role in our quest to identify effective ways to address the problem of polypharmacy and inappropriate prescribing, our previous finding that physicians and pharmacists perceive lack of time as an important barrier to deprescribing 17 becomes essential to address. Although healthcare systems might not easily adapt to allow more time for primary care clinicians to engage patients in conversations about deprescribing, possible solutions include educational interventions targeting the patient, as well as models of care that (1) streamline the deprescribing process using structured protocols, (2) recognize the role pharmacists can play in driving deprescribing and treatment optimization efforts in the community setting, (3) allow for a wider implementation of designated deprescribing clinics, and (4) recognize the importance of actively integrating pharmacists in primary care settings.…”

Section: Discussionmentioning

confidence: 99%

“…As part of a larger study, 17 we conducted a cross-sectional survey of patients taking multiple medications. Participants were recruited in November 2019 by trained research assistants at retail pharmacies associated with the University of Kentucky HealthCare system, a tertiary healthcare system serving patients from across the Commonwealth of Kentucky.…”

Section: Methodsmentioning

confidence: 99%

“…We recently published the results from the survey of clinicians and community pharmacists, the first study to compare primary care clinician and community pharmacist perceptions of deprescribing. 17 We identified important factors affecting the reported likelihood of deprescribing, including patient characteristics, time for counseling, communication, and trust within the clinician–patient–pharmacist triad. This article presents findings from the patient survey assessing beliefs and attitudes of patients taking multiple medications regarding deprescribing and their communication experiences with clinicians and pharmacists.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Lukacena

Keck

Freeman

et al. 2022

Therapeutic Advances in Drug Safety

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Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18 years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and pharmacists, and the revised Patients’ Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants ( n = 65 identified as female and n = 74 as White/Caucasian) with a mean age of 50.4 years [standard deviation (SD) = 15.5]. Participants reported taking an average of 8.4 daily medications (SD = 6.1). Most participants reported effective communication with clinicians and pharmacists (66.9%) and expressed willingness to stop one of their medications if their clinician said it was possible (83.5%). Predictors of willingness to accept deprescribing were older age [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.45–6.2], college/graduate degree (OR = 55.25, 95% CI = 5.74–531.4), perceiving medications as less appropriate (OR = 8.99, 95% CI = 1.1–73.62), and perceived effectiveness of communication with the clinician or pharmacist (OR = 4.56, 95% CI = 0.85–24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept deprescribing of medications when their doctor said it was possible. Targeted strategies to facilitate communication within the patient–primary care clinician–pharmacist triad that consider patient characteristics such as age and education level may be necessary ingredients for developing successful deprescribing interventions. Plain Language Summary Are patients willing to accept stopping medications? Sometimes, medicines that a patient takes regularly become inappropriate. In other words, the risks of adverse effects might be greater than a medicine’s potential benefits. The decision to stop such medicines should involve the patient and consider their preferences. We surveyed a group of patients taking multiple medicines to see how they felt about having those medicines stopped. We also asked patients whether and how much they talk to their primary care clinician and pharmacists about their medicines. To qualify for this study, patients had to be at least 18 years old and to take three or more medicines daily; they also needed to speak English. Participants provided demographic information and answered questions about their medicines, their communication with primary care clinicians and pharmacists, and their feelings about having one or more of their medicines stopped. We recruited 107 people and were able to use responses from 103 of them. Their average age was 50 years; 65 of them identified as female, and 75 identified as White/Caucasian. Most of our participants mentioned having conversations with primary care clinicians and pharmacists and said they would be willing to stop a medication if their clinician said it was possible. Older participants, those with more years of education, those who thought their medications might lead to side effects, and those who communicated with their clinician or pharmacists were more willing to have one of their medicines stopped. Our results indicate that patient characteristics and communication with clinicians and pharmacists are factors to consider when designing interventions to reduce the use of inappropriate medicines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Lukacena

Keck

Freeman

et al. 2022

Therapeutic Advances in Drug Safety

Self Cite

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“…The research team maintained open lines of communication with study sites. Systematic reviews have previously identified effective communication and collaboration strategies as important for deprescribing initiatives [ 6 , 31 – 33 ]. Using pharmacists already embedded in the primary care practices allowed us to capitalize on established communication processes and collaborative relationships to potentially build a lasting effect.…”

Section: Application Of the Seven Essential Components Of Knowledge T...mentioning

confidence: 99%

Implementation of pharmacist-led deprescribing in collaborative primary care settings

et al. 2022

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In many jurisdictions pharmacists share prescribing responsibilities with other members of the primary care team. Responsibility for deprescribing, the healthcare professional supervised withdrawal of medications that are no longer needed, has not been assumed by a specific member of the primary care team. In this commentary we describe implementation of pharmacist-led deprescribing in collaborative primary care settings using the seven components of knowledge translation. Patient and stakeholder engagement shaped the deprescribing intervention. The intervention was implemented in three collaborative primary care clinics in two Canadian provinces. The evaluation included measures of medication appropriateness, patient satisfaction, and healthcare professional satisfaction. Pharmacist-led deprescribing in primary care was acceptable to both patients and healthcare professionals and demonstrated a reduction of medications deemed to confer more risk than benefit. Our findings support successes in pharmacist-led deprescribing. Future work is needed to understand how to successfully implement and evaluate pharmacist-led deprescribing more widely.

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Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study

Roux

Rakheja

Sirois

et al. 2022

Eur J Clin Pharmacol

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Successful deprescribing requires understanding the attitudes of older adults and caregivers towards this process. This study aimed to capture these attitudes in four French-speaking countries, and to investigate associated factors. MethodsA multicenter cross-sectional study was conducted by administrating the French version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Belgium, Canada, France and Switzerland. Community-dwelling or nursing home older adults ≥ 65 years taking ≥ 1 prescribed medications, and caregivers of older adults with similar characteristics were included. Multivariate logistic regressions were carried out to examine factors associated with willingness to deprescribe. ResultsA total of 367 older adults (79.3 ± 8.7 years, 63% community-dwelling, 54% ≥5 medications) and 255 unrelated caregivers (64.4 ± 12.6 years) of care recipients (83.4 ± 7.9 years, 52% community-dwelling, 69% ≥5 medications) answered the questionnaire. Among them, 87.5% older adults and 75.6% caregivers would be willing to stop medications if the physician said it was possible. Reluctance to stop a medication taken for a long time was expressed by 46% of both older adults and caregivers. A low score for the factor "concerns about stopping" [older adults: aOR: 0.

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Primary care clinician and community pharmacist perceptions of deprescribing

Cited by 11 publications

References 8 publications

Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Implementation of pharmacist-led deprescribing in collaborative primary care settings

Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study

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