Using Shared Decision-Making to Address Possible Overtreatment in Patients at High Risk for Hypoglycemia: The Veterans Health Administration’s Choosing Wisely Hypoglycemia Safety Initiative

Wright, Samantha M.; Hedin, Sandra; McConnell, Mark; Burke, Brian; Watts, Sharon A.; Leslie, Donna; Aron, David C.; Pogach, Leonard

doi:10.2337/cd17-0060

Cited by 20 publications

(24 citation statements)

References 24 publications

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“…Recently, a frailty assessment pathway was proposed which could be incorporated in the diabetes care systems 45 . Furthermore, setting individualized treatment targets resulting in shared decisions about deprescribing requires education and involvement 30 . Informed people with diabetes and HCPs with sufficient communication skills are the basis of successful shared decision‐making.…”

Section: Discussionmentioning

confidence: 99%

“…15,16,[27][28][29][30][31][32][33][34][35][36][37][38] The study periods covered ranged from 2001 to 2017. Study methodologies comprised retrospective cohort studies, 15,16,[27][28][29][30][31] prospective cohort or before-and-after studies, [32][33][34][35][36] and surveys. 37,38 The studies looking at participant characteristics associated with deprescribing rates had a low risk of bias ( Figure 2).…”

Section: Study Characteristics and Biasmentioning

confidence: 99%

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Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review

2020

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Background Individualizing goals for people with type 2 diabetes may result in deintensification of medication, but a comprehensive picture of deprescribing practices is lacking. Aims To conduct a scoping review in order to assess the rates, determinants and success of implementing deprescribing of glucose‐, blood pressure‐ or lipid‐lowering medications in people with diabetes. Methods A systematic search on MEDLINE and Embase between January 2007 and January 2019 was carried out for deprescribing studies among people with diabetes. Outcomes were rates of deprescribing related to participant characteristics, the determinants and success of deprescribing, and its implementation. Critical appraisal was conducted using predefined tools. Results Fourteen studies were included; eight reported on rates, nine on determinants and six on success and implementation. Bias was high for studies on success of deprescribing. Deprescribing rates ranged from 14% to 27% in older people with low HbA1c levels, and from 16% to 19% in older people with low systolic blood pressure. Rates were not much affected by age, gender, frailty or life expectancy. Rates were higher when a reminder system was used to identify people with hypoglycaemia, which led to less overtreatment and fewer hypoglycaemic events. Most healthcare professionals accepted the concept of deprescribing but differed on when to conduct it. Deprescribing glucose‐lowering medications could be successfully conducted in 62% to 75% of participants with small rises in HbA1c. Conclusions Deprescribing of glucose‐lowering medications seems feasible and acceptable, but was not widely implemented in the covered period. Support systems may enhance deprescribing. More studies on deprescribing blood pressure‐ and lipid‐lowering medications in people with diabetes are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics and Biasmentioning

confidence: 99%

Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review

2020

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“…ADEs account for somewhere between 1.4% and 15.4% of hospital admissions in the United States and Canada, accounting for an estimated 177,504 emergency department visits by US patients aged ≥65 years and increasing the mean length of hospital stay from 8 to 20 days [ 18 - 20 ]. SDM is known to improve communication, lessen ADEs, and, overall, lower health care costs [ 21 , 22 ]. Through greater communication and collaboration between HCPs and patients, IP-SDM provides a platform that has significant potential to further lessen ADEs and to continue lower health care costs [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study

et al. 2018

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BackgroundPrimary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care.ObjectiveThe objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs.MethodsThis study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data.ResultsWe collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation.ConclusionsWe observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.

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“…That is some studies have shown positive results, meanwhile, others have failed to show such results. 39 , 52 , 53 , 54 , 55 , 56 Elderly patients are considered underrepresented age group and they are usually excluded from clinical trials about diabetes. 57 Studies which assessed the effectiveness of educational interventions on hypoglycaemia in patients with T2DM have either excluded elderly patients or included them with the young adult age groups.…”

Section: Discussionmentioning

confidence: 99%

“… 57 Studies which assessed the effectiveness of educational interventions on hypoglycaemia in patients with T2DM have either excluded elderly patients or included them with the young adult age groups. 39 , 52 , 53 , 54 , 55 , 56 This study specifically investigates the effect of counselling on older adults with T2DM.…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention

Almomani

Pascual

Al‐Azzam

et al. 2021

Research in Social and Administrative Pharmacy

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Introduction Hypoglycaemia is one of the most serious adverse effects of diabetes treatment. Older adults are at the highest risk to develop hypoglycaemia. Several studies have established the important positive role of educational interventions on achieving glycaemic control and other clinical outcomes, however, there is still a lack in studies that evaluate the impact of such type of interventions on hypoglycaemia risk in elderly patients with type 2 diabetes. The purpose of this research is to evaluate the effectiveness of pharmacist-led patient counselling on reducing hypoglycaemic attacks in older adults with type 2 diabetes mellitus. Methods and analysis: This study is an open-label, parallel controlled randomised trial, which will be conducted in the outpatient clinics at the largest referral hospital in the north of Jordan. Participants who are elderly (age ≥ 65 years), diagnosed with type 2 diabetes mellitus, and taking insulin, sulfonylurea, or any three anti-diabetic medications will be randomly assigned to intervention (SUGAR Handshake) and control (usual care) groups. The SUGAR Handshake participants will have an interactive, individualised, medications-focused counselling session reinforced with a pictogram and a phone call at week six of enrolment. The primary outcome measure is the frequency of total hypoglycaemic events within 12 weeks of follow up. Secondary outcomes include the frequency of asymptomatic, symptomatic, and severe hypoglycaemic events, hypoglycaemia incidence, and time to the first hypoglycaemic attack. We will also conduct a nested qualitative study for process evaluation. Ethics and dissemination The Human Research Ethics Committee of the University of Lincoln and the Institutional Review Board of King Abdullah University Hospital approved this protocol. The findings of this study will be presented in international conferences and published in a peer-reviewed journal. Trial registration number The study protocol has been registered with ClinicalTrials.gov , NCT04081766.

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Using Shared Decision-Making to Address Possible Overtreatment in Patients at High Risk for Hypoglycemia: The Veterans Health Administration’s Choosing Wisely Hypoglycemia Safety Initiative

Cited by 20 publications

References 24 publications

Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review

Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review

Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study

Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention

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