Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study
Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study
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DOI：
10.1111/jgs.16370
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发表时间：
2020-02-17
影响因子：
6.3
通讯作者：
Radomski, Thomas R.
中科院分区：
文献类型：
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作者：
Pickering, Aimee N.;Hamm, Megan E.;Radomski, Thomas R.
目标 共同决策对于取消老年人不必要或有害的药物治疗至关重要，但患者和护理人员对药物价值的看法以及这如何影响他们停止用药的意愿却知之甚少。我们试图从患者和护理人员的角度确定影响药物感知价值的最重要因素。 设计 使用焦点小组进行的定性研究于 2018 年 9 月和 10 月进行。 设置 来自匹兹堡大学维护的 Pepper 老年研究登记处（患者）和 Pitt+Me 登记处（护理人员）的参与者。 参与者 6 个焦点小组，由 65 岁或以上的社区居住成年人或其护理人员组成，开了 5 种处方过去 12 个月内服用过或更多药物。 测量 我们试图确定 (1) 对药物价值的一般看法以及药物值得服用的原因； (2) 成本或副作用等具体特征如何影响感知价值； (3) 对与停用相关的临床情况的反应。 结果 我们确定了四个主题。感知有效性是导致参与者认为药物具有高价值的主要因素。参与者认为，如果一种药物对生活质量产生不利影响，那么它的价值就很低。参与者在确定价值时还提到了成本，特别是当它导致物质牺牲时。参与者重视与他们有良好关系的提供者开出的药物，而不是重视培训水平。当呈现临床情景时，参与者在确定药物价值时巧妙地权衡了这些因素，并表明他们是否会遵守取消处方的建议。结论我们发现，感知的有效性、对生活质量的不利影响、成本以及与处方者的密切关系影响了患者和护理人员对药物价值的看法。这些发现将使处方医生能够在取消不必要的药物处方时让老年患者参与共同决策，并使卫生系统能够将以患者为中心的价值评估纳入基于系统的取消处方干预措施中。
OBJECTIVES Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults, yet patients' and caregivers' perspectives on medication value and how this affects their willingness to discontinue a medication are poorly understood. We sought to identify the most significant factors that impact the perceived value of a medication from the perspective of patients and caregivers.DESIGN Qualitative study using focus groups conducted in September and October 2018.SETTING Participants from the Pepper Geriatric Research Registry (patients) and the Pitt+Me Registry (caregivers) maintained by the University of Pittsburgh.PARTICIPANTS Six focus groups of community-dwelling adults aged 65 years or older, or their caregivers, prescribed five or more medications in the preceding 12 months.MEASUREMENTS We sought to identify (1) general views on medication value and what makes medication worth taking; (2) how specific features such as cost or side effects impact perceived value; and (3) reactions to clinical scenarios related to deprescribing.RESULTS We identified four themes. Perceived effectiveness was the primary factor that caused participants to consider a medication to be of high value. Participants considered a medication to be of low value if it adversely affected quality of life. Participants also cited cost when determining value, especially if it resulted in material sacrifices. Participants valued medications prescribed by providers with whom they had good relationships rather than valuing level of training. When presented with clinical scenarios, participants ably weighed these factors when determining the value of a medication and indicated whether they would adhere to a deprescribing recommendation.CONCLUSION We identified that perceived effectiveness, adverse effects on quality of life, cost, and a strong relationship with the prescriber influenced patients' and caregivers' views on medication value. These findings will enable prescribers to engage older patients in shared decision making when deprescribing unnecessary medications and will allow health systems to incorporate patient-centered assessment of value into systems-based deprescribing interventions.