Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study.

Autor: Green AR; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA. ariel@jhmi.edu., Boyd CM; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA., Gleason KS; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA., Wright L; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA., Kraus CR; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA., Bedoy R; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA., Sanchez B; University of Colorado School of Medicine, Aurora, CO, USA., Norton J; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA., Sheehan OC; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA., Wolff JL; Department of Health Policy and Management, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Reeve E; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia., Maciejewski ML; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA.; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA., Weffald LA; Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA., Bayliss EA; Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2020 Dec; Vol. 35 (12), pp. 3556-3563. Date of Electronic Publication: 2020 Jul 29.
DOI: 10.1007/s11606-020-06063-y
Abstrakt: Background: Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events.
Objectives: To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discussions in order to inform an intervention to increase awareness of deprescribing among individuals with dementia and MCC, family caregivers and primary care physicians. We also explored participant views on culturally competent approaches to deprescribing.
Design: Qualitative approach based on semi-structured interviews with patients, caregivers, and physicians.
Participants: Patients aged ≥ 65 years with claims-based diagnosis of dementia, ≥ 1 additional chronic condition, and ≥ 5 chronic medications were recruited from an integrated delivery system in Colorado and an academic medical center in Maryland. We included caregivers when present or if patients were unable to participate due to severe cognitive impairment. Physicians were recruited within the same systems and through snowball sampling, targeting areas with large African American and Hispanic populations.
Approach: We used constant comparison to identify and compare themes between patients, caregivers, and physicians.
Key Results: We conducted interviews with 17 patients, 16 caregivers, and 16 physicians. All groups said it was important to earn trust before deprescribing, frame deprescribing as routine and positive, align deprescribing with goals of dementia care, and respect caregivers' expertise. As in other areas of medicine, racial, ethnic, and language concordance was important to patients and caregivers from minority cultural backgrounds. Participants favored direct-to-patient educational materials, support from pharmacists and other team members, and close follow-up during deprescribing. Patients and caregivers favored language that explained deprescribing in terms of altered physiology with aging. Physicians desired communication tips addressing specific clinical situations.
Conclusions: Culturally sensitive communication within a trusted patient-physician relationship supplemented by pharmacists, and language tailored to specific clinical situations may support deprescribing in primary care for patients with dementia and MCC.
Databáze: MEDLINE
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