Deprescribing as an Opportunity to Facilitate Patient-Centered Care: A Qualitative Study of General Practitioners and Pharmacists in Japan

Ie, Kenya; Machino, Reiko; Albert, Steven M.; Tomita, Shiori; Kushibuchi, Mio; Hirose, Masahiro; Matsuda, Takahide; Okuse, Chiaki; Ohira, Yoshiyuki

doi:10.3390/ijerph20043543

Cited by 10 publications

(3 citation statements)

References 24 publications

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“… 13 Theory-informed interventions are few and there are opportunities for improvements in intervention design through stronger foundations on theoretical frameworks and behaviour change techniques. 128 140–144 Widespread variation exists in the everyday management of medicines and polypharmacy. 2 3 145–147 These variations occur at patient, prescriber, regional and international levels, and indicate links between problematic polypharmacy and health inequalities.…”

Section: Resultsmentioning

confidence: 99%

Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

Tsang,

Sperrin,

Blakeman

et al. 2024

BMJ Open

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IntroductionPolypharmacy and multimorbidity pose escalating challenges. Despite numerous attempts, interventions have yet to show consistent improvements in health outcomes. A key factor may be varied approaches to targeting patients for intervention.ObjectivesTo explore how patients are targeted for intervention by examining the literature with respect to: understanding how polypharmacy is defined; identifying problematic polypharmacy in practice; and addressing problematic polypharmacy through interventions.DesignWe performed a scoping review as defined by the Joanna Briggs Institute.SettingThe focus was on primary care settings.Data sourcesMedline, Embase, Cumulative Index to Nursing and Allied Health Literature and Cochrane along with ClinicalTrials.gov, Science.gov and WorldCat.org were searched from January 2004 to February 2024.Eligibility criteriaWe included all articles that had a focus on problematic polypharmacy in multimorbidity and primary care, incorporating multiple types of evidence, such as reviews, quantitative trials, qualitative studies and policy documents. Articles focussing on a single index disease or not written in English were excluded.Extraction and analysisWe performed a narrative synthesis, comparing themes and findings across the collective evidence to draw contextualised insights and conclusions.ResultsIn total, 157 articles were included. Case-finding methods often rely on basic medication counts (often five or more) without considering medical history or whether individual medications are clinically appropriate. Other approaches highlight specific drug indicators and interactions as potentially inappropriate prescribing, failing to capture a proportion of patients not fitting criteria. Different potentially inappropriate prescribing criteria also show significant inconsistencies in determining the appropriateness of medications, often neglecting to consider multimorbidity and underprescribing. This may hinder the identification of the precise population requiring intervention.ConclusionsImproved strategies are needed to target patients with polypharmacy, which should consider patient perspectives, individual factors and clinical appropriateness. The development of a cross-cutting measure of problematic polypharmacy that consistently incorporates adjustment for multimorbidity may be a valuable next step to address frequent confounding.

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Section: Resultsmentioning

confidence: 99%

Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

Tsang,

Sperrin,

Blakeman

et al. 2024

BMJ Open

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“…The use of MI techniques have demonstrated their effectiveness in various studies ( 31 , 32 ) and allows us to hypothesize that this intervention will be beneficial to a patient who is initially reluctant to stop or reduce his or her consumption of BZDR. Indeed, the literature suggests that MI is a powerful tool for BZDR deprescribing, as it is popular with healthcare professionals ( 33 ) and has been shown to be effective with other drugs such as opioids ( 34 ). A recently published review ( 35 ) described that different interventions had a positive impact as soon as they were based on patient empowerment ( 36–38 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

Huon,

Nizet,

Caillet

et al. 2023

Front. Med.

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BackgroundDeprescribing benzodiazepines and related drugs (BZDR) is a challenge due to a lack of time on physicians’ part, a lack of involvement of other health professionals, and the need for adapted tools. This study is based on primary care collaboration, by evaluating the effectiveness of a joint intervention between general practitioners and community pharmacists on the implementation of BZDR deprescribing in older adults.MethodsThis is a cluster randomized controlled trial in which each cluster will be formed by a physician-pharmacist pair. Within a cluster allocated to the intervention, the pharmacist will be trained in motivational interviewing (MI), and will offer the patient 3 interviews after inclusion by the physician. They will base their intervention on validated deprescribing guidelines. The pharmacist will receive methodological support during the first interviews. Interprofessional collaboration will be encouraged by writing reports for the physician after each interview. The following implementation outcomes will be evaluated: acceptability/adoption, appropriateness, cost, and fidelity. They will be measured by means of sociological interviews, observations, logbooks, and cost-utility analysis. Focus groups with physicians and pharmacists will be carried out to identify levers and barriers experienced in this collaboration. Observations will be conducted with pharmacists to assess their approach of the MIs. Effectiveness outcomes will be based on medication (discontinuation or reduction of BZDR) and clinical outcomes (such as quality of life, insomnia or anxiety), assessed by health insurance databases and validated questionnaires.DiscussionThis study will determine whether collaboration in primary care between physicians and pharmacists, as well as training and coaching of pharmacists in motivational interviewing, allows the implementation of BZDR deprescribing in the older adults.This study will provide an understanding of the processes used to implement deprescribing guidelines, and the contribution of collaborative practice in implementing BZDR discontinuation. The cluster methodology will allow to assess the experience of the relationship between the different primary care actors, and the related obstacles and levers.The results obtained will make it possible to produce guidelines on the involvement of community pharmacists in the management of substance abuse in older adults, or even to legislate new missions or care pathways.Clinical trial registrationClinicalTrials.gov, identifier, NCT05765656.

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“…Psychoeconomics of Healthcare Decisions delves into the psychosocial foundations of economic decision-making within the medical domain. It explores the intricate web of factors-individual behaviors, cultural contexts, and socio-economic environments-that intertwine to influence the choices we make regarding healthcare (Cranley et al, 2023;Ie et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

Introducing Psychoeconomics of Healthcare Decisions: Understanding the Why behind Our Choices

Cati

2024

PSYCH

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We introduce Psychoeconomics of Healthcare Decisions, a novel interdisciplinary field that sheds light on the "why" behind our medical choices. This field explores the intricate web of psychological factors, economic considerations, and individual behaviors that influence healthcare decision-making. By examining the impact of cultural contexts and socio-economic environments, Psychoeconomics of Healthcare Decisions offers a deeper understanding of patient choices. This knowledge has the potential to revolutionize healthcare delivery by empowering patients, informing policy decisions, and ultimately promoting preventive care utilization and treatment adherence. This manuscript lays the groundwork for this nascent field, outlining its potential to improve public health outcomes.

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Deprescribing as an Opportunity to Facilitate Patient-Centered Care: A Qualitative Study of General Practitioners and Pharmacists in Japan

Cited by 10 publications

References 24 publications

Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

Evaluation of the effectiveness of a joint general practitioner-pharmacist intervention on the implementation of benzodiazepine deprescribing in older adults (BESTOPH-MG trial): protocol for a cluster-randomized controlled trial

Introducing Psychoeconomics of Healthcare Decisions: Understanding the Why behind Our Choices

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