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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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| Published in: | Journal of general internal medicine : JGIM 2020-12, Vol.35 (12), p.3556-3563 |
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| container_title | Journal of general internal medicine : JGIM |
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| creator | 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. |
| description | 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. |
| doi_str_mv | 10.1007/s11606-020-06063-y |
| format | article |
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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.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-020-06063-y</identifier><identifier>PMID: 32728959</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>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</subject><ispartof>Journal of general internal medicine : JGIM, 2020-12, Vol.35 (12), p.3556-3563</ispartof><rights>Society of General Internal Medicine 2020</rights><rights>Society of General Internal Medicine 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-e5b2281ef2ec81dab12f313861c40d1c07e8099ac8946e8505e315b6a586d31c3</citedby><cites>FETCH-LOGICAL-c474t-e5b2281ef2ec81dab12f313861c40d1c07e8099ac8946e8505e315b6a586d31c3</cites><orcidid>0000-0003-4127-4617</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728901/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728901/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,733,786,790,891,27957,27958,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32728959$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Green, Ariel R.</creatorcontrib><creatorcontrib>Boyd, Cynthia M.</creatorcontrib><creatorcontrib>Gleason, Kathy S.</creatorcontrib><creatorcontrib>Wright, Leslie</creatorcontrib><creatorcontrib>Kraus, Courtney R.</creatorcontrib><creatorcontrib>Bedoy, Ruth</creatorcontrib><creatorcontrib>Sanchez, Bianca</creatorcontrib><creatorcontrib>Norton, Jonathan</creatorcontrib><creatorcontrib>Sheehan, Orla C.</creatorcontrib><creatorcontrib>Wolff, Jennifer L.</creatorcontrib><creatorcontrib>Reeve, Emily</creatorcontrib><creatorcontrib>Maciejewski, Matthew L.</creatorcontrib><creatorcontrib>Weffald, Linda A.</creatorcontrib><creatorcontrib>Bayliss, Elizabeth A.</creatorcontrib><title>Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>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.</description><subject>Aged</subject><subject>Aging</subject><subject>Caregivers</subject><subject>Chronic conditions</subject><subject>Chronic illnesses</subject><subject>Cognitive ability</subject><subject>Colorado</subject><subject>Dementia</subject><subject>Dementia - drug therapy</subject><subject>Dementia disorders</subject><subject>Deprescriptions</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Language</subject><subject>Maryland</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minority & ethnic groups</subject><subject>Original Research</subject><subject>Patients</subject><subject>Pharmacists</subject><subject>Physicians</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Qualitative research</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1DAUhi1ERacDL8ACWWLDJuBLLg4LJEihVCqiCFhbjnMy4ypjT21n0Oy6Z8kb8iR1mlIuC1a2db7_nPP7R-gxJc8pIdWLQGlJyowwkpF04dn-HlrQghUZzevqPloQIfJMVDw_REchXBBCOWPiATrkrGKiLuoF-n4MwayssSus8Lk3G-X3uFEefl79eKMCdPgYth6C9qadoFMbwe_ARuMs7p3H5yqa9Az4m4nrBG-mmsLKdvjDOESzHQA3a--s0bhxtjOTMrxM0z6NajAxyXeAP8ex2z9EB70aAjy6PZfo67u3X5r32dnHk9Pm9Vmm8yqPGRRtckGhZ6AF7VRLWc8pFyXVOemoJhUIUtdKizovQRSkAE6LtlSFKDtONV-iV3Pf7dhuoNNpY68GuZ3dS6eM_LtizVqu3E5W06-lT1yiZ7cNvLscIUS5MUHDMCgLbgyS5awmZUqHJfTpP-iFG71N9hJVcc7ykhaJYjOlvQvBQ3-3DCVyylrOWcuUtbzJWu6T6MmfNu4kv8JNAJ-BkEp2Bf737P-0vQZVQ7ib</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Green, Ariel R.</creator><creator>Boyd, Cynthia M.</creator><creator>Gleason, Kathy S.</creator><creator>Wright, Leslie</creator><creator>Kraus, Courtney R.</creator><creator>Bedoy, Ruth</creator><creator>Sanchez, Bianca</creator><creator>Norton, Jonathan</creator><creator>Sheehan, Orla C.</creator><creator>Wolff, Jennifer L.</creator><creator>Reeve, Emily</creator><creator>Maciejewski, Matthew L.</creator><creator>Weffald, Linda A.</creator><creator>Bayliss, Elizabeth A.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4127-4617</orcidid></search><sort><creationdate>20201201</creationdate><title>Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-e5b2281ef2ec81dab12f313861c40d1c07e8099ac8946e8505e315b6a586d31c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aging</topic><topic>Caregivers</topic><topic>Chronic conditions</topic><topic>Chronic illnesses</topic><topic>Cognitive ability</topic><topic>Colorado</topic><topic>Dementia</topic><topic>Dementia - drug therapy</topic><topic>Dementia disorders</topic><topic>Deprescriptions</topic><topic>Health care</topic><topic>Health care facilities</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Language</topic><topic>Maryland</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minority & ethnic groups</topic><topic>Original Research</topic><topic>Patients</topic><topic>Pharmacists</topic><topic>Physicians</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Qualitative research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Green, Ariel R.</creatorcontrib><creatorcontrib>Boyd, Cynthia M.</creatorcontrib><creatorcontrib>Gleason, Kathy S.</creatorcontrib><creatorcontrib>Wright, Leslie</creatorcontrib><creatorcontrib>Kraus, Courtney R.</creatorcontrib><creatorcontrib>Bedoy, Ruth</creatorcontrib><creatorcontrib>Sanchez, Bianca</creatorcontrib><creatorcontrib>Norton, Jonathan</creatorcontrib><creatorcontrib>Sheehan, Orla C.</creatorcontrib><creatorcontrib>Wolff, Jennifer L.</creatorcontrib><creatorcontrib>Reeve, Emily</creatorcontrib><creatorcontrib>Maciejewski, Matthew L.</creatorcontrib><creatorcontrib>Weffald, Linda A.</creatorcontrib><creatorcontrib>Bayliss, Elizabeth A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database (ProQuest)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Health Management Database (Proquest)</collection><collection>Medical Database</collection><collection>ProQuest research library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Green, Ariel R.</au><au>Boyd, Cynthia M.</au><au>Gleason, Kathy S.</au><au>Wright, Leslie</au><au>Kraus, Courtney R.</au><au>Bedoy, Ruth</au><au>Sanchez, Bianca</au><au>Norton, Jonathan</au><au>Sheehan, Orla C.</au><au>Wolff, Jennifer L.</au><au>Reeve, Emily</au><au>Maciejewski, Matthew L.</au><au>Weffald, Linda A.</au><au>Bayliss, Elizabeth A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>35</volume><issue>12</issue><spage>3556</spage><epage>3563</epage><pages>3556-3563</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32728959</pmid><doi>10.1007/s11606-020-06063-y</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4127-4617</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2020-12, Vol.35 (12), p.3556-3563 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7728901 |
| source | Springer Link; PubMed Central |
| 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 |
| title | Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study |
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