Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study

Background Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events. Objectives To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discu...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2020-12, Vol.35 (12), p.3556-3563
Main Authors: Green, Ariel R., Boyd, Cynthia M., Gleason, Kathy S., Wright, Leslie, Kraus, Courtney R., Bedoy, Ruth, Sanchez, Bianca, Norton, Jonathan, Sheehan, Orla C., Wolff, Jennifer L., Reeve, Emily, Maciejewski, Matthew L., Weffald, Linda A., Bayliss, Elizabeth A.
Format: Article
Language:English
Subjects:
Aged
Aging
Caregivers
Chronic conditions
Chronic illnesses
Cognitive ability
Colorado
Dementia
Dementia - drug therapy
Dementia disorders
Deprescriptions
Health care
Health care facilities
Humans
Internal Medicine
Language
Maryland
Medicine
Medicine & Public Health
Minority & ethnic groups
Original Research
Patients
Pharmacists
Physicians
Primary care
Primary Health Care
Qualitative research
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Summary:Background Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events. Objectives To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discussions in order to inform an intervention to increase awareness of deprescribing among individuals with dementia and MCC, family caregivers and primary care physicians. We also explored participant views on culturally competent approaches to deprescribing. Design Qualitative approach based on semi-structured interviews with patients, caregivers, and physicians. Participants Patients aged ≥ 65 years with claims-based diagnosis of dementia, ≥ 1 additional chronic condition, and ≥ 5 chronic medications were recruited from an integrated delivery system in Colorado and an academic medical center in Maryland. We included caregivers when present or if patients were unable to participate due to severe cognitive impairment. Physicians were recruited within the same systems and through snowball sampling, targeting areas with large African American and Hispanic populations. Approach We used constant comparison to identify and compare themes between patients, caregivers, and physicians. Key Results We conducted interviews with 17 patients, 16 caregivers, and 16 physicians. All groups said it was important to earn trust before deprescribing, frame deprescribing as routine and positive, align deprescribing with goals of dementia care, and respect caregivers’ expertise. As in other areas of medicine, racial, ethnic, and language concordance was important to patients and caregivers from minority cultural backgrounds. Participants favored direct-to-patient educational materials, support from pharmacists and other team members, and close follow-up during deprescribing. Patients and caregivers favored language that explained deprescribing in terms of altered physiology with aging. Physicians desired communication tips addressing specific clinical situations. Conclusions Culturally sensitive communication within a trusted patient-physician relationship supplemented by pharmacists, and language tailored to specific clinical situations may support deprescribing in primary care for patients with dementia and MCC.
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-020-06063-y