Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study

Peat, George; Fylan, Beth; Marques, Iuri; Raynor, David K.; Breen, Liz; Olaniyan, Janice; Alldred, David P.

doi:10.1136/bmjopen-2021-054279

Cited by 30 publications

(42 citation statements)

References 23 publications

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“…Deprescribing has been shown to be feasible and can be performed safely in older people [ 11 ], yet it can be difficult to initiate and sustain, and infrequently performed even when supported by decision-making tools [ 12 ]. Studies have identified that shared decision-making, gradual introduction of the topic, clear communication with the patient and working as part of a multidisciplinary team can facilitate deprescribing, whilst consultation constraints, patients' fears of negative consequences and difficulty understanding the terminology and information provided around deprescribing are perceived as barriers to deprescribing [ 13 , 14 ]. However, there is still a lack of a common understanding of what are the best practices or approaches for implementing deprescribing interventions in different cultures, healthcare systems, and clinical settings.…”

mentioning

confidence: 99%

Polypharmacy and deprescribing: challenging the old and embracing the new

O’Donnell

Ibrahim

2022

BMC Geriatr

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confidence: 99%

Polypharmacy and deprescribing: challenging the old and embracing the new

O’Donnell

Ibrahim

2022

BMC Geriatr

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“…Drawing on this work, we identified six themes related to barriers and facilitators of deprescribing. 43 This is analogous to the first phase of EBCD. In response to these themes, in this current phase of work, we completed a modified EBCD process to develop an intervention to address problematic polypharmacy in primary care.…”

Section: Introductionmentioning

confidence: 81%

“…These user priorities (from co-design) reflect the facilitators of deprescribing identified in preparatory work. 43 The professional priorities identified often supported, and do not fundamentally conflict with, the user priorities. However, professionals also identified the importance of: skill mix; clear roles and responsibilities; triggers to action; planning and guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Elsewhere, we have described our qualitative research that forms the first phase of EBCD in this case, that is, gathering information from service users and professionals about deprescribing experiences. 43 …”

Section: Methodsmentioning

confidence: 99%

“…[eFI] > 0.12) who were experienced in the daily management of multiple medicines for co-morbidities 43,46 ;…”

Section: Planning For Stakeholder Meetingsmentioning

confidence: 99%

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Co‐designing an intervention to improve the process of deprescribing for older people living with frailty in the United Kingdom

Silcock

Marques

Olaniyan

et al. 2022

Health Expectations

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Background: In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalization. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making.Objective: To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing.Design: Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A 'trigger film' showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritized and appropriate solutions were developed. The review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed.

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Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

Weir,

Shang,

Choi

et al. 2023

JAMA Netw Open

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ImportanceLittle is known about why older adults decline deprescribing recommendations, primarily because interventional studies rarely capture the reasons.ObjectiveTo examine factors important to older adults who disagree with a deprescribing recommendation given by a primary care physician to a hypothetical patient experiencing polypharmacy.Design, Setting, and ParticipantsThis online, vignette-based survey study was conducted from December 1, 2020, to March 31, 2021, with participants 65 years or older in the United Kingdom, the US, Australia, and the Netherlands. The primary outcome of the main study was disagreement with a deprescribing recommendation. A content analysis was subsequently conducted of the free-text reasons provided by participants who strongly disagreed or disagreed with deprescribing. Data were analyzed from August 22, 2022, to February 12, 2023.Main Outcomes and MeasuresAttitudes, beliefs, fears, and recommended actions of older adults in response to deprescribing recommendations.ResultsOf the 899 participants included in the analysis, the mean (SD) age was 71.5 (4.9) years; 456 participants (50.7%) were men. Attitudes, beliefs, and fears reported by participants included doubts about deprescribing (361 [40.2%]), valuing medications (139 [15.5%]), and a preference to avoid change (132 [14.7%]). Valuing medications was reported more commonly among participants who strongly disagreed compared with those who disagreed with deprescribing (48 of 205 [23.4%] vs 91 of 694 [13.1%], respectively; P &lt; .001) or had personal experience with the same medication class as the vignette compared with no experience (93 of 517 [18.0%] vs 46 of 318 [12.1%], respectively; P = .02). Participants shared that improved communication (225 [25.0%]), alternative strategies (138 [15.4%]), and consideration of medication preferences (137 [15.2%]) may increase their agreement with deprescribing. Participants who disagreed compared with those who strongly disagreed were more interested in additional communication (196 [28.2%] vs 29 [14.2%], respectively; P &lt; .001), alternative strategies (117 [16.9%] vs 21 [10.2%], respectively; P = .02), or consideration of medication preferences (122 [17.6%] vs 15 [7.3%], respectively; P &lt; .001).Conclusions and RelevanceIn this survey study, older adults who disagreed with a deprescribing recommendation were more interested in additional communication, alternative strategies, or consideration of medication preferences compared with those who strongly disagreed. These findings suggest that identifying the degree of disagreement with deprescribing could be used to tailor patient-centered communication about deprescribing in older adults.

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Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study

Cited by 30 publications

References 23 publications

Polypharmacy and deprescribing: challenging the old and embracing the new

Polypharmacy and deprescribing: challenging the old and embracing the new

Co‐designing an intervention to improve the process of deprescribing for older people living with frailty in the United Kingdom

Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

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