Health care providers’ roles and responsibilities in management of polypharmacy: Results of a modified Delphi

Abstract

Background: Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy. Objectives: to identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy. Methods: Four focus groups with 35 team members practising in geriatrics were generated to inform survey development. the sessions generated 63 competencies, roles or responsibilities, which were categorized into 4 domains defined by the canadian Interprofessional Health collaborative. the resulting survey was administered nationally to geriatric health care professionals who were asked to rate the importance of each item in managing polypharmacy; we sought agreement within and across professions using a confirmatory 2-round Delphi method. Results: round 1 was completed by 98 survey respondents and round 2 by 72. there was high intra-professional and interprofessional consensus regarding the importance of competencies among physicians, nurses and pharmacists; though pharmacists rated fewer competencies as important. Less consensus was observed among other health care professionals or they indicated the nonimportance of competencies despite focus group discussion to the contrary. Discussion: Although there is a strong consensus of polypharmacy management competencies across team members who have been more traditionally involved in medication management, there continue to be health care providers with differing understandings of competencies that may contribute to reduced reliance on medication. Lower importance ratings suggest pharmacists may not acknowledge or recognize their own potential roles in interprofessional polypharmacy management. Conclusion: Further exploration to understand the underutilization of professional expertise in managing polypharmacy will contribute to refining role clarity and translating competencies in practical settings, as well as guiding educators regarding curricular content.

“… Above All, It’s a Matter of This Person’s Quality of Life”: Health Care Professionals’ Perspectives on Deprescribing in Older Patients With Limited Life Expectancy

“…The participants in our study considered all groups of HCPs to play a crucial role in the deprescribing process. In a recent study, the authors explored different groups of HCPs' perceptions of responsibilities and roles in management of polypharmacy, including FPs, geriatricians, pharmacists, nurses, and social workers (Farrell, Thompson, et al, 2018). Consistent with our results, all groups considered themselves to hold competencies in terms of managing polypharmacy, although the number of identified competencies varied between the groups.…”

Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016

“…Pharmacists are not the only healthcare professionals who play a critical role in polypharmacy. In a survey of multifaceted healthcare providers, the findings showed that physicians, pharmacists, and nurses all agreed that preventing polypharmacy was a role they all were responsible for [ 23 ]. For example, nursing-led interventions have shown an improved adherence rate to oral (85% to 90%) and inhaled treatment (37 to 71%) in COPD patients [ 23 ].…”

“…In a survey of multifaceted healthcare providers, the findings showed that physicians, pharmacists, and nurses all agreed that preventing polypharmacy was a role they all were responsible for [ 23 ]. For example, nursing-led interventions have shown an improved adherence rate to oral (85% to 90%) and inhaled treatment (37 to 71%) in COPD patients [ 23 ]. There are multiple screening tools for physicians to be more mindful of the possibility of adverse effects to PIMs [ 24 ].…”

Decreasing Patient Falls by Including Medication Induced Factors in Fall Assessment

“…6,8,9 Addressing polypharmacy helps to reduce the chances of inpatient falls, inpatient falls with injuries, increased mortality rates, and increased patient costs. [4][5][6]10,11 However, addressing polypharmacy by deprescribing medications must be done with attention to withdrawal side effects and factors like frailty, which exacerbate the effects of FRIDs. 5,11 The experience of an inpatient fall causes feelings of stress, anxiety, and loss of confidence in patients after the occurrence.…”

“…[5][6][7][8][9]11,17 Researchers cite polypharmacy as hindering the quality of life, increasing the chance of falls with injuries, increasing patient costs, and increasing mortality rates. [4][5][6]10,11 Studies show barriers to deprescribing include FRIDs the patient may be taking, their willingness to cooperate, their patient history, factors related to frailty, and the need for expertise in deprescribing medications due to possible adverse effects. 5,11…”