What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals

Abstract

ObjectivesPolypharmacy and multimorbidity are common in long-term care facilities (LTCFs). Reducing polypharmacy may reduce adverse events and maintain quality of life. Deprescribing refers to reducing medications after consideration of therapeutic goals, benefits and risks, and medical ethics. The objective was to use nominal group technique (NGT) to generate then rank factors that general medical practitioners (GPs), nurses, pharmacists and residents or their representatives perceive are most important when deciding whether or not to deprescribe medications.DesignQualitative research using NGT.SettingParticipants were invited if they worked with, or resided in LTCFs across metropolitan and regional South Australia.Participants11 residents/representatives, 19 GPs, 12 nurses and 14 pharmacists participated across six separate groups.MethodsIndividual groups of GPs, nurses, pharmacists and residents/representatives were convened. Using NGT each group ranked factors perceived to be most important when deciding whether or not to deprescribe. Then, using NGT, the prioritised factors from individual groups were discussed and prioritised by a multidisciplinary metropolitan and regional group comprised of resident representatives, GPs, nurses and pharmacists.ResultsNo two groups had the same priorities. GPs ranked ‘evidence for deprescribing’ and ‘communication with family/resident’ as most important factors. Nurses ranked ‘GP receptivity to deprescribing’ and ‘nurses ability to advocate for residents’ as most important. Pharmacists ranked ‘clinical appropriateness of therapy’ and ‘identifying residents’ goals of care’ as most important. Residents ranked ‘wellbeing of the resident’ and ‘continuity of nursing staff’ as most important. The multidisciplinary groups ranked ‘adequacy of medical and medication history’ and ‘identifying residents’ goals of care’ as most important.ConclusionsWhile each group prioritised different factors, common and contrasting factors emerged. Future deprescribing interventions need to consider the similarities and differences within the range of factors prioritised by residents and health professionals.

Why deprescribing antipsychotics in older people with dementia in long‐term care is not always successful: Insights from the HALT study

“…More optimistically, there was good communication between the nurses and the GPs in relation to change in BPSD and (attempts at) nonpharmacological management. This is a noted facilitating factor for appropriate prescribing in long‐term care and may have been a positive by‐product of the HALT intervention even where withdrawal was not achieved. In addition, staff could identify positive changes upon antipsychotic withdrawal such as increased alertness and improved interaction …”

Older Adults’ Awareness of Deprescribing: A Population‐Based Survey

“…The questions in the current survey were therefore designed to determine the proportion of older adults with knowledge of medication harms and to assess the extent to which this knowledge is associated with initiation of a deprescribing conversation. Additionally, questions were developed to identify the sources of information that older adults use to acquire information about medication harms to determine potential barriers and optimize access to this information . An expert panel with clinical and research experience in geriatrics and deprescribing, consisting of specialist physicians, nurses, pharmacists, allied health professionals, and health researchers, reviewed the content validity of the survey questions.…”

Prescribing and Research in Medicines Management (UK & Ireland) Annual Conference 2017, University of Coventry London Campus, January 28th 2017: “Deprescribing ‐ is less more?”

“…Two studies, an Australian qualitative nominal group technique study involving residents, their relatives, GPs, pharmacists and care home staff and a Canadian survey of GPs found that the most significant barriers to deprescribing in care homes were incomplete medical histories, inaccessible relatives and patients with cognitive/communication difficulties. Prescribers were reluctant to deprescribe medicines started by specialists . Interviews have not yet been conducted.…”