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Denig P, Stuijt PJC. Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective, and interventions to support a proactive approach. Expert Rev Clin Pharmacol 2024; 17:637-654. [PMID: 39119644 DOI: 10.1080/17512433.2024.2378765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/24/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering and/or lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, deprescribing rates of these so-called cardiometabolic medications are low. A review of challenges and interventions addressing these challenges in this population is pertinent. AREAS COVERED We first provide an overview of relevant deprescribing recommendations. Next, we review challenges for healthcare providers (HCPs) to deprescribe cardiometabolic medication and provide insight in the patient and caregiver perspective on deprescribing. We summarize findings from research on implementing deprescribing of cardiometabolic medication and reflect on strategies to enhance deprescribing. We have used a combination of methods to search for relevant articles. EXPERT OPINION There is a need for rigorous development and evaluation of intervention strategies aimed at proactive deprescribing of cardiometabolic medication. To address challenges at different levels, these should be multifaceted interventions. All stakeholders must become aware of the relevance of deintensifying medication in this population. Education and training for HCPs and patients should support patient-centered communication and shared decision-making. Development of procedures and tools to select eligible patients and conduct targeted medication reviews are important for implementation of deprescribing in routine care.
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Affiliation(s)
- Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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Sun T, Xu X, Ding Z, Xie H, Ma L, Zhang J, Xia Y, Zhang G, Ma Z. Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e53006. [PMID: 38578692 PMCID: PMC11031705 DOI: 10.2196/53006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/22/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with "adherence" playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. OBJECTIVE The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. METHODS A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. RESULTS The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (-7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. CONCLUSIONS The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/46883.
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Affiliation(s)
- Ting Sun
- Graduate School, University of Science and Technology of China, Hefei, China
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Xuejie Xu
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Zenghui Ding
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Hui Xie
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Linlin Ma
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Jing Zhang
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Yuxin Xia
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Guoli Zhang
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Zuchang Ma
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
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Almukhtar A, Batcup C, Bowman M, Winter-Beatty J, Leff D, Demirel P, Porat T, Judah G. Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework. Int J Surg 2024; 110:554-568. [PMID: 37889570 PMCID: PMC10793789 DOI: 10.1097/js9.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The health sector contributes significantly to the climate crisis. Operating theatres (OTs) in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. The authors systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in OTs, categorising these using the Theoretical Domains Framework (TDF). MATERIALS AND METHODS Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 and June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines. RESULTS Twenty-one studies were selected for analysis and assessment (17 surveys and four interview studies) comprising 8286 participants, including surgeons, nurses, and anaesthetists. Eighteen themes across 10 TDF domains were identified. The most common barriers to adoption of green behaviours in OTs were in domains of: 'knowledge' ( N =18), for example knowledge of sustainable practices; 'environmental context and resources' ( N =16) for example personnel shortage and workload and inadequate recycling facilities; 'social influences' ( N =9) for example lack of leadership/organisational mandate or support; 'beliefs about consequences' ( N =9) for example concerns regarding safety. Intention was the most common facilitator, with 11 studies citing it. CONCLUSIONS Despite intentions to adopt sustainable practices in OTs, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff's knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the hospital and trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise OTs.
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Affiliation(s)
- Aws Almukhtar
- Department of General Surgery, Imperial College Healthcare NHS Trust
- Department of Surgery and Cancer, St Mary’s Hospital
| | - Carys Batcup
- Dyson School of Design Engineering, Imperial College London
| | - Miranda Bowman
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Daniel Leff
- Department of Surgery and Cancer, St Mary’s Hospital
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Pelin Demirel
- Dyson School of Design Engineering, Imperial College London
| | - Talya Porat
- Dyson School of Design Engineering, Imperial College London
| | - Gaby Judah
- Department of Surgery and Cancer, St Mary’s Hospital
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Kennie-Kaulbach N, Ramsay E, Gormley H, Isenor JE. Making it happen: Development of an interprofessional deprescribing education programme. Basic Clin Pharmacol Toxicol 2024; 134:107-115. [PMID: 37818667 DOI: 10.1111/bcpt.13950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/12/2023]
Abstract
Deprescribing is the planned and supervised reduction or discontinuation of medications that may be causing harm or are no longer benefiting a patient. The need for deprescribing to be a routine part of patient care is essential with an aging population and the rising prevalence of polypharmacy, which has been associated with increased adverse outcomes such as falls, hospitalizations and mortality. Deprescribing is a complex intervention that requires collaboration between the patient, caregivers and healthcare providers to adequately support all involved, as well as to ensure medications are not restarted in error. The objective of this article is to describe the stepwise approach to planning and ongoing development of an online, interprofessional deprescribing education programme for healthcare providers and students with the goal of enhancing deprescribing practice. There were four main planning and development components: (1) a needs assessment to provide guidance on programme design, development and delivery; (2) a consultative programme planning process with an advisory group of stakeholders and patient partners to inform programme learning outcomes and content; (3) a core development team for the creation of programme content; and (4) planning for programme evaluation. Based on the stepwise and consultative process, programme outcomes were identified, and five modules were developed.
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Affiliation(s)
| | - Emma Ramsay
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Gormley
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer E Isenor
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
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Advani SD, Claeys K. Behavioral Strategies in Diagnostic Stewardship. Infect Dis Clin North Am 2023; 37:729-747. [PMID: 37537001 DOI: 10.1016/j.idc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Diagnostic stewardship refers to the responsible and judicious use of diagnostic tests to reduce low value care and improve patient outcomes. This article provides an overview of behavioral strategies, their relevance to diagnostic stewardship and highlights behavioral determinants that drive diagnostic testing behavior, drawing on theoretic frameworks. Additionally, we provide concrete examples of evidence-based behavioral strategies for promoting appropriate diagnostic testing while acknowledging associated challenges. Finally, we highlight the significance of evaluating these strategies and provide an overview of evaluation frameworks and methods.
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Affiliation(s)
- Sonali D Advani
- Department of Internal Medicine-Infectious Diseases, Duke University School of Medicine, 315 Trent Drive, Hanes House, Suite 154, Durham, NC 27710, USA.
| | - Kimberly Claeys
- Department of Pharmacy Science and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Heinrich CH, McHugh S, McCarthy S, Curran GM, Donovan MD. Multidisciplinary DEprescribing review for Frail oldER adults in long-term care (DEFERAL): Implementation strategy design using behaviour science tools and stakeholder engagement. Res Social Adm Pharm 2023:S1551-7411(23)00252-8. [PMID: 37230873 DOI: 10.1016/j.sapharm.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Deprescribing is a strategy for reducing the use of potentially inappropriate medications for older adults. Limited evidence exists on the development of strategies to support healthcare professionals (HCPs) deprescribing for frail older adults in long-term care (LTC). OBJECTIVE To design an implementation strategy, informed by theory, behavioural science and consensus from HCPs, which facilitates deprescribing in LTC. METHODS This study was consisted of 3 phases. First, factors influencing deprescribing in LTC were mapped to behaviour change techniques (BCTs) using the Behaviour Change Wheel and two published BCT taxonomies. Second, a Delphi survey of purposively sampled HCPs (general practitioners, pharmacists, nurses, geriatricians and psychiatrists) was conducted to select feasible BCTs to support deprescribing. The Delphi consisted of two rounds. Using Delphi results and literature on BCTs used in effective deprescribing interventions, BCTs which could form an implementation strategy were shortlisted by the research team based on acceptability, practicability and effectiveness. Finally, a roundtable discussion was held with a purposeful, convenience sample of LTC general practitioners, pharmacists and nurses to prioritise factors influencing deprescribing and tailor the proposed strategies for LTC. RESULTS Factors influencing deprescribing in LTC were mapped to 34 BCTs. The Delphi survey was completed by 16 participants. Participants reached consensus that 26 BCTs were feasible. Following the research team assessment, 21 BCTs were included in the roundtable. The roundtable discussion identified lack of resources as the primary barrier to address. The agreed implementation strategy incorporated 11 BCTs and consisted of an education-enhanced 3-monthly multidisciplinary team deprescribing review, led by a nurse, conducted at the LTC site. CONCLUSION The deprescribing strategy incorporates HCPs' experiential understanding of the nuances of LTC and thus addresses systemic barriers to deprescribing in this context. The strategy designed addresses five determinants of behaviour to best support HCPs engaging with deprescribing.
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Affiliation(s)
| | - Sheena McHugh
- School of Public Health, University College Cork, Ireland.
| | | | - Geoffrey M Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, United States; Central Arkansas Veterans Healthcare System, United States.
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Omuya H, Nickel C, Wilson P, Chewning B. A systematic review of randomised-controlled trials on deprescribing outcomes in older adults with polypharmacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023:7156969. [PMID: 37155330 DOI: 10.1093/ijpp/riad025] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Mixed findings about deprescribing impact have emerged from varied study designs, interventions, outcome measures and targeting sub-categories of medications or morbidities. This systematic review controls for study design by reviewing randomised-controlled trials (RCTs) of deprescribing interventions using comprehensive medication profiles. The goal is to provide a synthesis of interventions and patient outcomes to inform healthcare providers and policy makers about deprescribing effectiveness. OBJECTIVES This systematic review aims to (1) review RCT deprescribing studies focusing on complete medication reviews of older adults with polypharmacy across all health settings, (2) map patients' clinical and economic outcomes against intervention and implementation strategies and (3) inform research agendas based on observed benefits and best practices. METHODS The PRISMA framework for systematic reviews was followed. Databases used were EBSCO Medline, PubMed, Cochrane Library, Scopus and Web of Science. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomised trials. RESULTS Fourteen articles were included. Interventions varied in setting, preparation, use of interdisciplinary teams, validated guidelines and tools, patient-centredness and implementation strategy. Thirteen studies (92.9%) found deprescribing interventions reduced the number of drugs and/or doses taken. No studies found threats to patient safety in terms of primary outcomes including morbidity, hospitalisations, emergency room use and falls. Four of five studies identifying health quality of life as a primary outcome found significant effects associated with deprescribing. Both studies with cost as their primary outcome found significant effects as did two with cost as a secondary outcome. Studies did not systematically study how intervention components influenced deprescribing impact. To explore this gap, this review mapped studies' primary outcomes to deprescribing intervention components using the Consolidated Framework for Implementation Research. Five studies had significant, positive primary outcomes related to health-related quality of life (HRQOL), cost and/or hospitalisation, with four reporting patient-centred elements in their intervention. CONCLUSIONS RCT primary outcomes found deprescribing is safe and reduces drug number or dose. Five RCTs found a significant deprescribing impact on HRQOL, cost or hospitalisation. Important future research agendas include analysing (1) understudied outcomes like cost, and (2) intervention and implementation components that enhance effectiveness, such as patient-centred elements.
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Affiliation(s)
- Helen Omuya
- Health Services Research in Pharmacy, School of Pharmacy, University of Wisconsin Madison, Madison WI
| | - Clara Nickel
- School of Pharmacy, University of Wisconsin Madison, Madison WI
| | - Paije Wilson
- Ebling Library for the Health Sciences, University of Wisconsin Madison, Madison, WI, USA
| | - Betty Chewning
- Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, WI, USA
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Coteur K, Van Nuland M, Schoenmakers B, Van den Broeck K, Anthierens S. "At the time I only wanted to relieve stress": Exploring motivation for behaviour change in long-term hypnotic users. Heliyon 2023; 9:e16215. [PMID: 37234622 PMCID: PMC10205632 DOI: 10.1016/j.heliyon.2023.e16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Background Motivating patients to discontinue long-term benzodiazepine receptor agonist (BZRA) use for insomnia remains an important challenge in primary care because of the medication's unfavourable risk-benefit profile. Previous studies have shown that understanding the complexity of patients' motivation is crucial to the primary care physician for providing effective interventions efficiently. Theoretical frameworks about behaviour change show that motivation is a multi-layered concept that interacts with other concepts, which aligns with a holistic perspective or implementation of the biopsychosocial model. Aim Exploring primary care patients' views and ideas on what factors helped or hindered them in discontinuing long-term BZRA use, in relation to motivation as conceptualised in the Behaviour Change Wheel, and associated domains of the Theoretical Domains Framework. Design and setting A qualitative study with semi-structured interviews in primary care in Belgium between September 2020 and March 2021. Method Eighteen interviews with long-term hypnotic users were audio recorded, transcribed and thematically analyzed, using the Framework Method. Results The success of discontinuation interventions does not solely rely on patients' spontaneous sense of striving for improvement. Reinforcement and identity were found to be important domains for motivation. Beliefs about personal capabilities, and about consequences of both BZRA intake and discontinuation, differed between previous and current users. Conclusion Motivation is a multi-layered concept which is not fixed in time. Patient empowerment and goal setting could help long-term BZRA users to lower their intake. As well as public health interventions that might change social attitudes towards the use of hypnotic medication.
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Affiliation(s)
- Kristien Coteur
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Belgium
| | - Marc Van Nuland
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Belgium
| | - Kris Van den Broeck
- Department of Family Medicine and Population Health, University of Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Belgium
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Farrell B, Rousse-Grossman J, Santamaria C, McCarthy LM. Applying the Behaviour Change Wheel to support deprescribing in long-term care: Qualitative interviews with stakeholder participants. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100256. [PMID: 37091629 PMCID: PMC10113898 DOI: 10.1016/j.rcsop.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Background Implementation and behavioural science are increasingly being used to support development and translation of evidence-based interventions into practice. We used the Behaviour Change Wheel (BCW) approach in two stakeholder forums to identify target behaviours and supporting actions to inform the development of a framework to support deprescribing in long-term care homes. During our planning for these forums, we found many applications of the BCW approach used in healthcare. However, we found no accounts of stakeholders' experiences when the BCW approach was used with large groups of people who were mostly unfamiliar with behavioural science. Objective The goal of this research was to gain insight into the use of the BCW approach in the context of developing a framework to support deprescribing in long-term care. Methods This descriptive qualitative study employed one-on-one semi-structured interviews with Ontario long-term care stakeholders who had participated in one or both of two in-person forums that we hosted. Interviews were transcribed verbatim and an inductive content-analysis approach was used to code data and determine themes. Results Fifteen interviews were conducted. Four themes were identified. First, the BCW was new and made sense, but people found it hard to identify target behaviours before planning solutions. Second, participants varied in their opinions as to whether the 'right' people were participating. Third, participants found that the forum activities, worksheets and facilitators helped people use the approach. Fourth, stakeholder perspectives about potential implementation challenges and strategies to maximize success were identified. Conclusions Overall, participants were positive about the use of the BCW approach, however, its usefulness could be optimized by enhancing explanations, facilitation and logistics to ensure an initial focus on targeting behaviours. Making stakeholder perspectives transparent and ensuring mechanisms are present to ensure all views are sought and considered are also important to optimizing participant experience.
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Keller MS, Carrascoza-Bolanos J, Breda K, Kim LY, Kennelty KA, Leang DW, Murry LT, Nuckols TK, Schnipper JL, Pevnick JM. Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour (COM-B) Model: a qualitative study. BMJ Open 2023; 13:e066234. [PMID: 36813499 PMCID: PMC9950911 DOI: 10.1136/bmjopen-2022-066234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES Geriatric guidelines strongly recommend avoiding benzodiazepines and non-benzodiazepine sedative hypnotics in older adults. Hospitalisation may provide an important opportunity to begin the process of deprescribing these medications, particularly as new contraindications arise. We used implementation science models and qualitative interviews to describe barriers and facilitators to deprescribing benzodiazepines and non-benzodiazepine sedative hypnotics in the hospital and develop potential interventions to address identified barriers. DESIGN We used two implementation science models, the Capability, Opportunity and Behaviour Model (COM-B) and the Theoretical Domains Framework, to code interviews with hospital staff, and an implementation process, the Behaviour Change Wheel (BCW), to codevelop potential interventions with stakeholders from each clinician group. SETTING Interviews took place in a tertiary, 886-bed hospital located in Los Angeles, California. PARTICIPANTS Interview participants included physicians, pharmacists, pharmacist technicians, and nurses. RESULTS We interviewed 14 clinicians. We found barriers and facilitators across all COM-B model domains. Barriers included lack of knowledge about how to engage in complex conversations about deprescribing (capability), competing tasks in the inpatient setting (opportunity), high levels of resistance/anxiety among patients to deprescribe (motivation), concerns about lack of postdischarge follow-up (motivation). Facilitators included high levels of knowledge about the risks of these medications (capability), regular rounds and huddles to identify inappropriate medications (opportunity) and beliefs that patients may be more receptive to deprescribing if the medication is related to the reason for hospitalisation (motivation). Potential modes of delivery included a seminar aimed at addressing capability and motivation barriers in nurses, a pharmacist-led deprescribing initiative using risk stratification to identify and target patients at highest need for deprescribing, and the use of evidence-based deprescribing education materials provided to patients at discharge. CONCLUSIONS While we identified numerous barriers and facilitators to initiating deprescribing conversations in the hospital, nurse- and pharmacist-led interventions may be an appropriate opportunity to initiate deprescribing.
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Affiliation(s)
- Michelle S Keller
- Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Health Policy and Management, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Kathleen Breda
- Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Linda Y Kim
- Nursing, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Korey A Kennelty
- College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - Donna W Leang
- Pharmacy, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Logan T Murry
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa, USA
| | - Teryl K Nuckols
- Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeffrey L Schnipper
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joshua M Pevnick
- Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Kennie-Kaulbach N, Gormley H, McSweeney-Flaherty JM, Cassidy C, Kits O, Trenaman S, Isenor JE. Supporting Interprofessional Collaboration in Deprescribing: Needs Assessment for an Education Program. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:208-211. [PMID: 36547938 DOI: 10.1097/ceh.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/19/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION : Deprescribing is a complex process involving patients and healthcare providers. The aim of the project was to examine the learning needs and preferences of healthcare providers and students to inform the development of an interprofessional deprescribing education program. METHODS : An online survey of pharmacists, nurses, nurse practitioners, family physicians, and associated students practicing or studying in Nova Scotia was conducted. Respondents were recruited by purposive and snowball sampling to have at least five respondents within each professional/student group. Questions captured participant's self-reported comfort level and professional role for 12 deprescribing tasks and their learning preferences. RESULTS : Sixty-nine respondents (46 healthcare providers and 23 students) completed the questionnaire. Average comfort levels for all 12 deprescribing tasks ranged from 40.22 to 78.90 of 100. Respondents reported their preferred deprescribing learning activities as watching videos and working through case studies. Healthcare providers preferred to learn asynchronously online, while students preferred a mix of online and in-person delivery. DISCUSSION : Learning needs related to deprescribing tasks and roles were identified, as well as preferences for format and delivery of education. Development of an education program that can provide a shared understanding of collaborative deprescribing tailored to learner preferences may improve deprescribing in practice.
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Affiliation(s)
- Natalie Kennie-Kaulbach
- Natalie Kennie-Kaulbach: Assistant Professor, College of Pharmacy, Dalhousie University, Nova Scotia, Canada. Hannah Gormley: Pharmacy Student, College of Pharmacy, Dalhousie University, Nova Scotia, Canada. Jill Marie McSweeney-Flaherty: Adjunct Professor, Dalhousie University, Assistant Director, Centre for Advancement of Teaching and Learning, Elon University, Elon, NC. Christine Cassidy: Assistant Professor, School of Nursing, Dalhousie University, Nova Scotia, Canada, and Affiliate Scientist, IWK Health, Nova Scotia, Canada. Olga Kits: Qualitative Methodologist, Research Methods Unit, Nova Scotia Health and Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada. Shanna Trenaman: Postdoctoral Fellow, Geriatric Medicine Research, Department of Medicine, Dalhousie University, Nova Scotia, Canada. Jennifer E. Isenor: Associate Professor, College of Pharmacy and Department of Community Health & Epidemiology, Dalhousie University, Nova Scotia, Canada
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