Motivating deprescribing conversations for patients with Alzheimer's disease and related dementias: a descriptive study.
Motivating deprescribing conversations for patients with Alzheimer's disease and related dementias: a descriptive study.
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DOI：
10.1177/20420986221118143
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发表时间：
2022
影响因子：
4.4
通讯作者：
Mazor, Kathleen M.
中科院分区：
文献类型：
--
作者：
Antonelli, Mary T.;Cox, John S.;Saphirak, Cassandra;Gurwitz, Jerry H.;Singh, Sonal;Mazor, Kathleen M.
关键词：
患有阿尔茨海默病和相关痴呆症 (ADRD) 的老年人因处方可能不适当的药物而受到伤害的风险增加。鼓励患者和护理人员与他们的提供者讨论可能不适当的药物可能会刺激减少处方。我们的目标是探讨向 ADRD 患者邮寄教育材料是否可以促使患者或护理人员与他们的提供者就可能不适当的药物进行对话。我们对 ADRD 患者、ADRD 患者的护理人员以及医疗保健提供者进行了半结构化访谈。所有参与者都看到了教育材料，其中提到了可能不适当的药物以及促进取消处方的建议。访谈探讨了对材料的反应、患者和护理人员发起关于取消处方的对话的想法以及取消处方的过程。使用归纳主题分析对访谈笔录进行分析。我们总共进行了 27 次访谈：9 次仅采访护理人员，2 次仅采访患者，3 次采访患者-护理人员二人组，13 次采访提供者。患者和护理人员报告说，如果某种药物可能造成伤害，他们会主动与医疗服务提供者讨论该药物。对提供者的信任可能会促进或抑制此类对话；如果之前有向提供者提出问题的积极经历，那么对话的可能性就更大。医疗服务提供者乐于接受患者和护理人员就其药物展开对话，因为他们重视取消处方作为临床实践的一部分，并欢迎知情的患者和护理人员参与药物决策。向社区 ADRD 患者邮寄有关可能不适当药物的教育材料可能会促进取消处方的对话。正在进行的务实试验将确定此类干预措施是否会刺激取消处方的对话并减少不适当药物的处方。 鼓励阿尔茨海默病患者与其医疗服务提供者讨论可能造成伤害的药物 简介：患有阿尔茨海默病和相关痴呆症 (ADRD) 的老年人有时会开出可能造成伤害的药物，尤其是长时间服用时。患者及其护理人员可能不知道这些风险。医生知道这些风险，但由于优先事项相互竞争或为这些具有复杂需求的患者提供护理时面临其他挑战，他们可能无法解决这些风险。鼓励患者或其护理人员与医生讨论他们的药物可能有助于减少无益药物的使用。本研究的目的是探讨向 ADRD 患者发送教育材料是否可以鼓励患者或护理人员向医生询问他们的药物治疗情况。方法：我们采访了 ADRD 患者、护理人员和医生。我们向他们展示了教育材料，建议患者及其护理人员与医生讨论减少或停止可能有害的药物。我们询问了对这些材料的反应以及对与医生讨论停止用药的想法的反应。结果：我们进行了 27 次访谈：9 次仅与护理人员进行访谈，2 次仅与患者进行访谈，3 次与患者-护理人员二人组进行访谈，12 次与医生进行访谈。患者和护理人员表示，得知某种药物可能会造成伤害会促使他们与医生讨论该药物。对医生的信任很重要。一些患者和护理人员很乐意询问有关药物的问题，而另一些患者则不愿意质疑医生。医生对患者和护理人员询问药物问题持开放态度，并认为患者不要服用不需要的药物很重要。结论：向 ADRD 患者和护理人员发送教育材料可能会鼓励他们与医生讨论停止或减少药物治疗。需要进行研究以了解此类材料是否会导致潜在有害药物处方的减少。
Older adults with Alzheimer’s disease and related dementias (ADRD) are at increased risk of harm due to prescribing of potentially inappropriate medications. Encouraging patients and caregivers to talk with their providers about potentially inappropriate medications could stimulate deprescribing. Our objective was to explore whether mailing educational materials to patients with ADRD might activate patients or caregivers to initiate a conversation with their provider about potentially inappropriate medications. We conducted semi-structured interviews with patients with ADRD, caregivers of patients with ADRD, and healthcare providers. All participants were shown educational materials referencing potentially inappropriate medications and suggestions to promote deprescribing. Interviews explored reactions to the materials, the idea of patients and caregivers initiating a conversation about deprescribing, and the deprescribing process. Interview transcripts were analyzed using inductive thematic analysis. We conducted a total of 27 interviews: 9 with caregivers only, 2 with patients only, 3 with patient–caregiver dyads, and 13 with providers. Patients and caregivers reported that if a medication might cause harm, it would motivate them to talk to their provider about the medication. Trust in the provider could facilitate or inhibit such conversations; conversations would be more likely if there were prior positive experiences asking questions of the provider. Providers were receptive to patients and caregivers initiating conversations about their medications, as they valued deprescribing as part of their clinical practice and welcome informed patients and caregivers as participants in decision-making about medication. Mailing educational materials about potentially inappropriate medications to community-dwelling patients with ADRD may promote deprescribing conversations. Ongoing pragmatic trials will determine whether such interventions stimulate deprescribing conversations and achieve reductions in prescribing of inappropriate medications. Encouraging patients with Alzheimer’s disease to talk with their providers about medications that may cause harm Introduction: Older adults with Alzheimer’s disease and related dementias (ADRD) are sometimes prescribed medications that may cause harm, especially when taken for extended periods of time. Patients and their caregivers may not know about the risks. Doctors know of the risks but may not address them due to competing priorities or other challenges in providing care to these patients with complex needs. Encouraging the patient or their caregiver to talk to their doctor about their medications might help to reduce the use of medications that are not beneficial. This study’s goal was to explore whether sending educational materials to patients with ADRD might encourage patients or caregivers to ask their doctor about their medications. Methods: We interviewed patients with ADRD, caregivers, and doctors. We showed them educational materials that suggested patients and their caregivers talk to their doctor about reducing or stopping medications that may be harmful. We asked for reactions to the materials and to the idea of talking to the doctor about stopping the medication. Results: We conducted 27 interviews: 9 with caregivers only, 2 with patients only, 3 with patient–caregiver dyads, and 12 with doctors. Patients and caregivers said learning that a medication might cause harm would motivate them to talk to their doctor about the medication. Trust in their doctor was important. Some patients and caregivers were comfortable asking questions about medications, while others were reluctant to challenge the doctor. Doctors were open to patients and caregivers asking about medications and felt it was important that patients not take medications that are not needed. Conclusion: Sending educational materials to patients with ADRD and caregivers may encourage them to talk with their doctors about stopping or reducing medications. Studies are needed to learn whether such materials lead to reductions in prescribing of potential harmful medications.
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DOI：
10.1111/hex.13318
发表时间：
2021-10
期刊：
Health expectations : an international journal of public participation in health care and health policy
影响因子：
--
作者：
Gench M;Sawan MJ;Langford A;Gnjidic D
通讯作者：
Gnjidic D
DOI：
10.1016/j.amjopharm.2007.12.002
发表时间：
2007-12-01
期刊：
The American journal of geriatric pharmacotherapy
影响因子：
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作者：
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通讯作者：
Hanlon, Joseph T
影响因子：
4.4
作者：
Bloomstone S;Anzuoni K;Cocoros N;Gurwitz JH;Haynes K;Nair VP;Platt R;Rochon PA;Singh S;Mazor KM
通讯作者：
Mazor KM
影响因子：
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作者：
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通讯作者：
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影响因子：
3.4
作者：
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Onder, Graziano