Intervention design in cognitively impaired populations-Lessons learned from the OPTIMIZE deprescribing pragmatic trial.

Autor: Sheehan OC; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; Department of Geriatric Medicine, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland., Gleason KS; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA., Bayliss EA; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.; Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA., Green AR; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Drace ML; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA., Norton J; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Reeve E; Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia.; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia., Shetterly SM; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA., Weffald LA; Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, Colorado, USA., Sawyer JK; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA., Maciejewski ML; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Medical Center, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA., Kraus C; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA., Maiyani M; Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA., Wolff J; School of Public Health, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Boyd CM; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; School of Public Health, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2023 Mar; Vol. 71 (3), pp. 774-784. Date of Electronic Publication: 2022 Dec 12.
DOI: 10.1111/jgs.18148
Abstrakt: Background: Polypharmacy is common in older adults with cognitive impairment and multiple chronic conditions, increasing risks of adverse drug events, hospitalization, and death. Deprescribing, the process of reducing or stopping potentially inappropriate medications, may improve outcomes. The OPTIMIZE pragmatic trial examined whether educating and activating patients, family members and clinicians about deprescribing reduces number of chronic medications and potentially inappropriate medications. Acceptability and challenges of intervention delivery in cognitively impaired older adults are not well understood.
Methods: We explored mechanisms of intervention implementation through post hoc qualitative interviews and surveys with stakeholder groups of 15 patients, 7 caregivers, and 28 clinicians. We assessed the context in which the intervention was delivered, its implementation, and mechanisms of impact.
Results: Acceptance of the intervention was affected by contextual factors including cognition, prior knowledge of deprescribing, communication, and time constraints. All stakeholder groups endorsed the acceptability, importance, and delivery of the intervention. Positive mechanisms of impact included patients scheduling specific appointments to discuss deprescribing and providers being prompted to consider deprescribing. Recollection of intervention materials was inconsistent but most likely shortly after intervention delivery. Short visit times remained the largest provider barrier to deprescribing.
Conclusions: Our work identifies key learnings in intervention delivery that can guide future scaling of deprescribing interventions in this population. We highlight the critical roles of timing and repetition in intervention delivery to cognitively impaired populations and the barrier posed by short consultation times. The acceptability of the intervention to patients and family members highlights the potential to incorporate deprescribing education into routine clinical practice and expand proven interventions to other vulnerable populations.
(© 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
Databáze: MEDLINE
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