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

Publication ,  Journal Article
Green, AR; Boyd, CM; Gleason, KS; Wright, L; Kraus, CR; Bedoy, R; Sanchez, B; Norton, J; Sheehan, OC; Wolff, JL; Reeve, E; Maciejewski, ML ...
Published in: J Gen Intern Med
December 2020

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.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

December 2020

Volume

35

Issue

12

Start / End Page

3556 / 3563

Location

United States

Related Subject Headings

  • Primary Health Care
  • Maryland
  • Humans
  • General & Internal Medicine
  • Deprescriptions
  • Dementia
  • Colorado
  • Caregivers
  • Aged
  • 4206 Public health
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Green, A. R., Boyd, C. M., Gleason, K. S., Wright, L., Kraus, C. R., Bedoy, R., … Bayliss, E. A. (2020). Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study. J Gen Intern Med, 35(12), 3556–3563. https://doi.org/10.1007/s11606-020-06063-y
Green, Ariel R., Cynthia M. Boyd, Kathy S. Gleason, Leslie Wright, Courtney R. Kraus, Ruth Bedoy, Bianca Sanchez, et al. “Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study.J Gen Intern Med 35, no. 12 (December 2020): 3556–63. https://doi.org/10.1007/s11606-020-06063-y.
Green AR, Boyd CM, Gleason KS, Wright L, Kraus CR, Bedoy R, et al. Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study. J Gen Intern Med. 2020 Dec;35(12):3556–63.
Green, Ariel R., et al. “Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study.J Gen Intern Med, vol. 35, no. 12, Dec. 2020, pp. 3556–63. Pubmed, doi:10.1007/s11606-020-06063-y.
Green AR, Boyd CM, Gleason KS, Wright L, Kraus CR, Bedoy R, Sanchez B, Norton J, Sheehan OC, Wolff JL, Reeve E, Maciejewski ML, Weffald LA, Bayliss EA. Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study. J Gen Intern Med. 2020 Dec;35(12):3556–3563.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

December 2020

Volume

35

Issue

12

Start / End Page

3556 / 3563

Location

United States

Related Subject Headings

  • Primary Health Care
  • Maryland
  • Humans
  • General & Internal Medicine
  • Deprescriptions
  • Dementia
  • Colorado
  • Caregivers
  • Aged
  • 4206 Public health