The role of older patients’ goals in GP decision-making about medicines: a qualitative study

Weir, Kristie Rebecca; Naganathan, Vasi; Carter, Stacy M; Tam, Chun Wah Michael; McCaffery, Kirsten; Bonner, Carissa; Rigby, Debbie; McLachlan, Andrew J.; Jansen, Jesse

doi:10.1186/s12875-020-01347-y

Cited by 19 publications

(22 citation statements)

References 42 publications

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“…The physicians described how the patient’s narrative was sometimes overlooked when decisions for medical treatment were made. It has been suggested previously that general practitioners (GPs) have different practice patterns when working with older persons health care goals [ 46 ]. In one pattern, GPs try to convince their patients of what the medical goal should be, rather than having the patient express their own personal goals.…”

Section: Discussionmentioning

confidence: 99%

“…This practice pattern was described by some of the physicians in the current study and is not consistent with the person-centered approach. Another practice pattern described how a patient’s goals were important, but that the GP had a strong focus on avoiding risk and ensuring safety for the older person [ 46 ]. It was evident in the current study that several of the physicians shared this view.…”

Section: Discussionmentioning

confidence: 99%

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The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study

et al. 2022

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Background An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care. Methods A phenomenographic qualitative study design, with semi-structured interviews using an interview guide. Results Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making. Conclusions The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study

et al. 2022

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“…In Part B, GPs will be asked to attach the patient’s medication list to the questionnaire and indicate which medications they would be willing to deprescribe. The GP questionnaire will contain sociodemographic questions, questions about work practices, and decision-making preferences (“GP profile”) based on previous qualitative research [ 46 ]. Details on the individual components of the questionnaire, and how they related to the study objectives, are provided in Table 3 .…”

Section: Methods and Analysismentioning

confidence: 99%

“… 5) GP questionnaire asking if and why GPs would stop/reduce any of their patients’ medications, questions regarding their relationship with the patient, and sociodemographic questions. We also use adapted questions from the Control Preference Scale [ 49 ], GP typology [ 46 ], and Prescribers’ Perceptions of Medication Discontinuation Survey [ 50 ]. 6) To explore the views of older adults on the use and deprescribing of herbal and dietary supplements.…”

Section: Methods and Analysismentioning

confidence: 99%

Understanding older patients’ willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries

et al. 2022

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Introduction To reduce inappropriate polypharmacy, deprescribing should be part of patients’ regular care. Yet deprescribing is difficult to implement, as shown in several studies. Understanding patients’ attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults’ perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients’ willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions. Methods and analysis This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (n = 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients’ medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements. Discussion The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients’ preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs’ and patients’ views and preferences on stopping or reducing specific medications. Our findings will help to understand patients’ attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients’ preferences.

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“…Actions to increase patient involvement by improving their knowledge of their medication and efforts to put such knowledge into practice may enable patients to exert greater control over their medical treatment [23]. Accordingly, developing tools that provide the GP with feedback from patients on their goals and preferences have been suggested as a possible strategy for medicines optimisation [24,25].…”

Section: Introductionmentioning

confidence: 99%

Involving patients in medicines optimisation in general practice: a development study of the “PREparing Patients for Active Involvement in medication Review” (PREPAIR) tool

et al. 2022

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Background Many patients have multiple health conditions and take multiple medications (polypharmacy). Active patient involvement may improve treatment outcomes and ensure patient-centred care. Yet, patient involvement remains a challenge in clinical practice. We aimed to develop and pilot test a questionnaire-based preparation and dialogue tool, the PREparing Patients for Active Involvement in medication Review (PREPAIR) tool, to encourage the involvement of patients with polypharmacy in medicines optimisation in general practice. Methods We conducted a literature review followed by a co-production process to develop the tool: a workshop with six GPs and pilot testing, including observations and interviews, with 22 patients, three GPs and three practice staff. During this process, we made continuous adaptations to the prototype. We analysed the qualitative data thematically, focusing on the development process and mechanisms of impact. Findings The final PREPAIR tool included five items concerning the patient’s experience of 1) adverse drug reactions, 2) excess medication, 3) unnecessary medication, 4) medication satisfaction and 5) medication-related topics to discuss with the GP (open-ended question). The applied workflow during testing was as follows; the patient completed the PREPAIR tool at home, to encourage reflection on the medication, and brought it to the GP consultation. During the consultation, the GP and the patient reviewed the patient’s responses and discussed potential medication-related problems. For some patients, the increased reflection led to worries about the medications. Still, the pilot testing showed that, when using the PREPAIR tool, the patients arrived at the clinic well prepared and empowered to speak. From the PREPAIR-supported dialogue, the GPs obtained a better understanding of patients’ perspectives and provided a more patient-centred consultation. For the patients, the PREPAIR-supported dialogue ultimately promoted an increased sense of security, satisfaction and insight into their medication, despite initial worries for some patients. Conclusions We developed a brief tool to support active patient involvement in medication review in general practice. The PREPAIR-tool was well received by both patients and GPs and fitted well into the existing clinical practice. Our findings suggest that the PREPAIR-tool can support patient involvement during consultations and facilitate patient-centred care.

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The role of older patients’ goals in GP decision-making about medicines: a qualitative study

Cited by 19 publications

References 42 publications

The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study

The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study

Understanding older patients’ willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries

Involving patients in medicines optimisation in general practice: a development study of the “PREparing Patients for Active Involvement in medication Review” (PREPAIR) tool

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