Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study
Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study
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DOI：
10.3399/bjgp16x685669
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发表时间：
2016-08-01
影响因子：
5.9
通讯作者：
Hilmer, Sarah N.
中科院分区：
文献类型：
--
作者：
Reeve, Emily;Low, Lee-Fay;Hilmer, Sarah N.
背景取消处方描述了安全有效地停用可能弊大于利的药物所需的复杂过程。了解老年人和照顾者对停药的态度将促进他们在用药优化方面的共同决策。目的探讨老年人和照顾者对停药的看法、信念和态度。设计和设置定性焦点小组研究在澳大利亚新南威尔士州。结果老年人和照顾者停用一种或多种药物的意愿受到以下主题的影响：他们对药物适当性的感知；对停药结果的恐惧；不喜欢服药；以及停药过程的可用性(包括与医疗保健专业人员的讨论，并知道必要时可以重新开始用药)。患者的常规全科医生被认为是支持和反对停药的强烈影响因素。所确定的主题支持先前制定的框架。护理者特有的另一个主题是为他们的护理对象做出药物决定的复杂性。结论这项研究强调，医疗保健专业人员与老年人或照顾者之间关于停药的讨论应该解决停药的原因。全科医生应该意识到他们对患者的主要影响，并定期与老年人及其照顾者讨论当前药物使用的适当性。
Background Deprescribing describes the complex process that is required for the safe and effective cessation of medications that are likely to cause more harm than benefit. Knowledgeof older adults' and carers' attitudes towards deprescribing will enhance shared decision making in medication optimisation.Aim To explore the views, beliefs, and attitudes of older adults and carers on deprescribing.Design and setting Qualitative focus group study in New South Wales, Australia.Method Four focus groups with 14 older adults and 14 carers were conducted. Results were analysed using a previously developed framework (directed content analysis) with additional conventional content analysis.Results The willingness of both older adults and carers to have one or more medications deprescribed was influenced by the following main themes: their perception of the appropriateness of that medication; fear of outcomes of withdrawal; dislike of taking medications; and the availability of a process for withdrawal (including a discussion with a healthcare professional and knowing that the medication could be restarted if necessary). A patient's regular GP was identified as a strong influence both for and against medication withdrawal. The identified themes supported the previously developed framework. An additional theme unique to the carers was the complexity involved in making decisions about medications for their care recipients.Conclusion This study highlights that discussions between the healthcare professional and the olderadult or carer about withdrawing medications should address reasons for deprescribing. GPs should be aware of their major influence on patients and regularly discuss appropriateness of current medication use with older adults and their carers.