Patient and Physician Perspectives of Deprescribing Potentially Inappropriate Medications in Older Adults with a History of Falls: a Qualitative Study.

Autor: Hahn EE; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. Erin.E.Hahn@kp.org., Munoz-Plaza CE; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA., Lee EA; Division of Internal Medicine, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA., Luong TQ; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA., Mittman BS; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA., Kanter MH; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA., Singh H; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.; Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Danforth KN; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.; RTI International, Research Triangle Park, NC, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2021 Oct; Vol. 36 (10), pp. 3015-3022. Date of Electronic Publication: 2021 Jan 19.
DOI: 10.1007/s11606-020-06493-8
Abstrakt: Background: High-risk medications pose serious safety risks to older adults, including increasing the risk of falls. Deprescribing potentially inappropriate medications (PIMs) in older adults who have experienced a fall is a key element of fall reduction strategies. However, continued use of PIMs in older adults is common, and clinicians may face substantial deprescribing barriers.
Objective: Explore patient and clinician experiences with and perceptions of deprescribing PIMs in patients with a history of falls.
Design: We led guided patient feedback sessions to explore deprescribing scenarios with patient stakeholders and conducted semi-structured interviews with primary care physicians (PCPs) to explore knowledge and awareness of fall risk guidelines, deprescribing experiences, and barriers and facilitators to deprescribing.
Participants: PCPs from Kaiser Permanente Southern California (KPSC) and patient members of the KPSC Regional Patient Advisory Committee.
Approach: We used maximum variation sampling to identify PCPs with patients who had a fall, then categorized the resulting PIM dispense distribution for those patients into high and low frequency. We analyzed the data using a hybrid deductive-inductive approach. Coders applied initial deductively derived codes to the data, simultaneously using an open-code inductive approach to capture emergent themes.
Key Results: Physicians perceived deprescribing discussions as potentially contentious, even among patients with falls. Physicians reported varying comfort levels with deprescribing strategies: some felt that the conversations might be better suited to others (e.g., pharmacists), while others had well-planned negotiation strategies. Patients reported lack of clarity as to the reasons and goals of deprescribing and poor understanding of the seriousness of falls.
Conclusions: Our study suggests that key barriers to deprescribing include PCP trepidation about raising a contentious topic and insufficient patient awareness of the potential seriousness of falls. Findings suggest the need for multifaceted, multilevel deprescribing approaches with clinician training strategies, patient educational resources, and a focus on building trusting patient-clinician relationships.
(© 2021. Society of General Internal Medicine.)
Databáze: MEDLINE
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