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Ailabouni NJ, Thompson W, Hilmer SN, Quirke L, McNeece J, Bourke A, Furst C, Reeve E. Co-Designing a Consult Patient Decision Aid for Continuation Versus Deprescribing Cholinesterase Inhibitors in People Living with Dementia. Drugs Aging 2024:10.1007/s40266-024-01146-5. [PMID: 39289289 DOI: 10.1007/s40266-024-01146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND AND OBJECTIVE As dementia progresses, people living with dementia may take high-risk, unnecessary, or ineffective medicines. Cholinesterase inhibitors (ChEIs) may have benefit in some people with dementia; however, up to one third are continued when no longer necessary or safe. Our aim was to co-design a consult patient decision aid (CPtDA) to support shared decision making between healthcare professionals and consumers about continuing or deprescribing ChEIs. METHODS A systematic process was employed to design and test the CPtDA prototype. First, a steering group composed of healthcare professionals and a consumer representative was assembled. Guided by the International Patient Decision Aids Standards, the steering group defined the CPtDA's purpose, scope, and target audience and drafted the prototype for further testing. Interviews with consumers and healthcare professionals were conducted to gain feedback on the content, format, structure, comprehensibility and usability of the CPtDA prototype. RESULTS After the steering group developed the CPtDA prototype, interviews were conducted with 11 consumers and six healthcare professionals. The content and format of the decision aid were improved iteratively over three rounds after consolidating the feedback at each round. The main changes included rewording the purpose of the decision aid and simplifying its layout and format. Participants reported that the decision aid is comprehensible and may be useful in practice. CONCLUSIONS Limited available resources guide shared decision making about deprescribing. This study resulted in a co-designed and alpha-tested CPtDA for people living with dementia and carers to help them review the ongoing need for their ChEIs. Further research is needed to explore using the CPtDA in practice to support people living with dementia and their carers engage in the shared decision-making process about continuing or deprescribing their ChEIs. Our co-designed CPtDA could help people living with dementia and their carers review their goals of care alongside their healthcare professional. This may prompt conversations about appropriately using ChEIs and increase the uptake of deprescribing.
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Affiliation(s)
- Nagham J Ailabouni
- Pharmacy Australian Centre of Excellence, Health and Behavioural Science Department, School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD, 4102, Australia.
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah N Hilmer
- Northern Clinical School, Faculty of Medicine and Health, Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Lyntara Quirke
- Dementia Advocate, Dementia Australia, Brisbane, QLD, Australia
| | - Janet McNeece
- Royal Adelaide Hospital, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Alice Bourke
- Aged Care, Rehabilitation and Palliative Care (Medical), Northern Adelaide Local health Network, Adelaide, Australia
| | - Chloe Furst
- Royal Adelaide Hospital, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Caulfield East, VIC, Australia
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Hild S, Teigné D, Fairier D, Ruelle Y, Aubin-Auger I, Sidorkiewicz S, Citrini M, Gocko X, Cerisey C, Ferrat E, Rat C. Development and evaluation of a decision aid for women eligible for organized breast cancer screening according to international standards: A multi-method study. Breast 2024; 73:103613. [PMID: 38056169 PMCID: PMC10749284 DOI: 10.1016/j.breast.2023.103613] [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: 07/13/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND and purpose: In France, women lack information to make a shared decision to start breast cancer screening. Decision aids are useful to facilitate this discussion, yet few meet international standards. The objective of this project was to build, validate and measure the quality of a decision aid for organized breast screening in France, in line with international standards, intended for both women and healthcare professionals. MATERIALS AND METHODS This mixed-methods study was conducted between January 2017 and June 2022. The prototype was developed from a qualitative study, systematic review and targeted literature review and alpha tested during two Delphi rounds. Readability was evaluated with the Flesch score and content with International Patient Decision Aid Standards Instrument (IPSASi). RESULTS An online decision aid, accessible at www.Discutons-mammo.fr, written in French was developed. The content included eligibility, information about breast screening the advantages and disadvantages of screening, patient preferences and a patient-based discussion guide using text, infographics, and videos. The Flesch readability test score was 65.4 and the IPDASi construct quality score was 176 out of 188. CONCLUSIONS This decision aid complies with IPDASi standards and could help women eligible for breast screening in France make a shared decision with a specialized healthcare professional about whether or not to participate in organized breast screening.
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Affiliation(s)
- Sandrine Hild
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France.
| | - Delphine Teigné
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France; University Research Department, Nantes University Hospital, Nantes, France.
| | - Damien Fairier
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France; University Research Department, Nantes University Hospital, Nantes, France.
| | - Yannick Ruelle
- Department of General Practice, Sorbonne University Paris Nord, UR 3412, DUMG, F-93430, Villetaneuse, France.
| | | | | | - Marie Citrini
- Patient Perspective, Sorbonne University, Paris, Nord, France.
| | - Xavier Gocko
- University Jean Monnet of Saint Etienne, Department of Medicine, Saint Etienne, France.
| | | | - Emilie Ferrat
- University Paris-Est Creteil, INSERM, IMRB, Equipe CEpiA, F-94010, Creteil, Paris, France.
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France; National Institute for Health and Medical Research/INSERM U1302 Team 2, CRCINA, Nantes, France.
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Gendre P, Mocquard J, Artarit P, Chaslerie A, Caillet P, Huon JF. (De)Prescribing of proton pump inhibitors: what has changed in recent years? an observational regional study from the French health insurance database. BMC PRIMARY CARE 2022; 23:341. [PMID: 36582006 PMCID: PMC9800230 DOI: 10.1186/s12875-022-01941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases. METHODS This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were included, defined as patients who has had PPI dispensed for 3 consecutive months with a temporal coverage of at least 80%. Patients under 18 years of age and patients who received parenteral PPIs only were excluded. RESULTS The percentage of chronic treatment discontinuation in 2017 was 12.5% and remained stable to reach 12.4% in 2020. The number of new chronic patients increased from year to year to reach 77,222 patients in 2020, with an increasing rate of 1.2 to 2% between 2017 and 2020. The prevalent patient population increased from year to year to reach 167 751 patients in 2020, with an increasing rate of 4.2 to 4.4% between 2017 and 2020. Regarding the initiation of PPI therapy, in 2020, 87.1% of treatment initiations were done by general practitioners. They renewed 2,402,263 prescriptions (89.3%) between 2017 and 2020. CONCLUSIONS This study shows a stagnation over the last 4 years in the deprescribing of chronic PPI treatments in a French region despite the information on their inappropriate use reported by national agencies and in the literature with increasing frequency. This reinforces the interest of setting up a deprescribing project.
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Affiliation(s)
- Pauline Gendre
- grid.277151.70000 0004 0472 0371Pharmacy, Nantes Université, CHU Nantes, 44000 Nantes, France
| | - Julie Mocquard
- grid.277151.70000 0004 0472 0371Pharmacy, Nantes Université, CHU Nantes, 44000 Nantes, France
| | - Pascal Artarit
- Medical Department, French National Health Insurance, DRSM, Nantes, France
| | - Anicet Chaslerie
- Medical Department, French National Health Insurance, DRSM, Nantes, France
| | - Pascal Caillet
- grid.277151.70000 0004 0472 0371Public Health Department, Nantes Université, CHU Nantes, 44000 Nantes, France
| | - Jean-François Huon
- grid.277151.70000 0004 0472 0371Pharmacy, Nantes Université, CHU Nantes, 44000 Nantes, France
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Nguyen-Soenen J, Rat C, Gaultier A, Schirr-Bonnans S, Tessier P, Fournier JP. Effectiveness of a multi-faceted intervention to deprescribe proton pump inhibitors in primary care: protocol for a population-based, pragmatic, cluster-randomized controlled trial. BMC Health Serv Res 2022; 22:219. [PMID: 35177042 PMCID: PMC8851828 DOI: 10.1186/s12913-022-07496-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 02/07/2023] Open
Abstract
Background Inappropriately using proton pump inhibitors (PPI) is associated with severe adverse drug reactions and may have major consequences on healthcare costs. Deprescribing (the process by which a healthcare professional supervises the withdrawal of an inappropriate medication, to manage polypharmacy and improve outcomes) should be considered when an inappropriate PPI prescription is identified. Deprescribing interventions directed solely to prescribers have limited efficacy and are rarely targeted to patients. The aim of this trial is to assess the efficacy of a multi-faceted intervention with patients and general practitioners (GPs) to deprescribe PPI. Methods We will conduct a pragmatic, cluster-randomized, population-based, controlled trial in two regions of Western France. GPs with practices with over 100 patients, and their adult patient to whom over 300 defined daily doses (DDD) of PPIs have been dispensed in the year before baseline will be included. A total of 1300 GPs and 33,000 patients will be cluster-randomized by GPs practices. Three arms will be compared: i) a multi-faceted intervention associating a) a patient education brochure about PPI deprescribing sent directly to patients (the brochure was designed using a mixed-methods study), and b) a personalized letter with the Bruyere’s PPI deprescribing algorithm sent to their respective GPs, or ii) a single intervention where only the GPs received the letter and algorithm, or iii) no intervention. The primary outcome will be PPI deprescribing, defined as the proportion of patients achieving at least a 50% decrease in the amount of PPI dispensed to them (DDD/year) at 12 months compared to baseline. Secondary outcomes will include incremental cost-utility ratio (using EQ-5D-5L scale and National Health Insurance’s database), acid rebound (using the Gastroesophageal Reflux Disease Impact Scale), and the patients’ attitudes towards deprescribing (using the French rPATD). Discussion Based on previous trials, we anticipate more than 10% “successful PPI deprescribing” in the multi-faceted intervention compared to the single intervention on GPs and the control arm. The study has been funded through a national grant and will be launched in autumn 2020, for early results by the end of 2022. Trial registration Clinicaltrials.gov NCT04255823; first registered on February 5, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07496-3.
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Affiliation(s)
- Jérôme Nguyen-Soenen
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France. .,SPHERE - UMR INSERM 1246, Université de Nantes, Université de Tours, Nantes, France.
| | - Cédric Rat
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France
| | - Aurélie Gaultier
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France.,Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Solène Schirr-Bonnans
- CHU de Nantes, Service Évaluation Économique et Développement des Produits de Santé, Nantes Université, Nantes, France
| | - Philippe Tessier
- SPHERE - UMR INSERM 1246, Université de Nantes, Université de Tours, Nantes, France.,CHU de Nantes, Service Évaluation Économique et Développement des Produits de Santé, Nantes Université, Nantes, France
| | - Jean-Pascal Fournier
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France.,SPHERE - UMR INSERM 1246, Université de Nantes, Université de Tours, Nantes, France
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