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Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study

Potentially inappropriate medications (PIMs) may harm adults over the age of 65, yet PIMs are prescribed at high rates. The process of deprescribing PIMs is challenging in the primary care setting, particularly among older adult patients with multiple chronic conditions. While barriers to deprescrib...

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Autores principales: Brady, Laura, LaValley, Susan, Ranahan, Molly, Clark, Collin, Monte, Scott, Jacobs, David, Wahler, Robert, Singh, Ranjit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740390/
http://dx.doi.org/10.1093/geroni/igaa057.1209
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author Brady, Laura
LaValley, Susan
Ranahan, Molly
Clark, Collin
Monte, Scott
Jacobs, David
Wahler, Robert
Singh, Ranjit
author_facet Brady, Laura
LaValley, Susan
Ranahan, Molly
Clark, Collin
Monte, Scott
Jacobs, David
Wahler, Robert
Singh, Ranjit
author_sort Brady, Laura
collection PubMed
description Potentially inappropriate medications (PIMs) may harm adults over the age of 65, yet PIMs are prescribed at high rates. The process of deprescribing PIMs is challenging in the primary care setting, particularly among older adult patients with multiple chronic conditions. While barriers to deprescribing are well known, less data are available on the facilitators and strategies that primary care providers consider key to successful deprescribing. This study examines providers’ perceptions and attitudes of deprescribing to identify individual and systems-level facilitators and strategies for successful deprescribing. Data were collected through semi-structured interviews with 20 providers recruited from primary care practices located in Western New York. Rapid thematic analysis was used to identify the facilitators and strategies providers perceived as important to successful deprescribing. Facilitators included providers adapting their approach to deprescribing PIMs based on their knowledge of the patient. Providers’ own characteristics were also important, as were those of their organization, including whether a clinical pharmacist was available to consult. Strategies for deprescribing were patient-focused (e.g., adapting to patient’s lifestyle), process-focused (e.g., patient education on polypharmacy), and medication-focused (e.g., tapering). It is clear that many of the primary care providers who treat a larger number of older adults are aware of the importance of deprescribing PIMs. However, deprescribing in a busy primary-care setting is challenging. Findings detailing providers’ perceptions of facilitators and strategies for deprescribing can guide future interventions and target support to reduce the risk of harm from PIMs in older adults.
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spelling pubmed-77403902020-12-21 Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study Brady, Laura LaValley, Susan Ranahan, Molly Clark, Collin Monte, Scott Jacobs, David Wahler, Robert Singh, Ranjit Innov Aging Abstracts Potentially inappropriate medications (PIMs) may harm adults over the age of 65, yet PIMs are prescribed at high rates. The process of deprescribing PIMs is challenging in the primary care setting, particularly among older adult patients with multiple chronic conditions. While barriers to deprescribing are well known, less data are available on the facilitators and strategies that primary care providers consider key to successful deprescribing. This study examines providers’ perceptions and attitudes of deprescribing to identify individual and systems-level facilitators and strategies for successful deprescribing. Data were collected through semi-structured interviews with 20 providers recruited from primary care practices located in Western New York. Rapid thematic analysis was used to identify the facilitators and strategies providers perceived as important to successful deprescribing. Facilitators included providers adapting their approach to deprescribing PIMs based on their knowledge of the patient. Providers’ own characteristics were also important, as were those of their organization, including whether a clinical pharmacist was available to consult. Strategies for deprescribing were patient-focused (e.g., adapting to patient’s lifestyle), process-focused (e.g., patient education on polypharmacy), and medication-focused (e.g., tapering). It is clear that many of the primary care providers who treat a larger number of older adults are aware of the importance of deprescribing PIMs. However, deprescribing in a busy primary-care setting is challenging. Findings detailing providers’ perceptions of facilitators and strategies for deprescribing can guide future interventions and target support to reduce the risk of harm from PIMs in older adults. Oxford University Press 2020-12-16 /pmc/articles/PMC7740390/ http://dx.doi.org/10.1093/geroni/igaa057.1209 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Brady, Laura
LaValley, Susan
Ranahan, Molly
Clark, Collin
Monte, Scott
Jacobs, David
Wahler, Robert
Singh, Ranjit
Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study
title Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study
title_full Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study
title_fullStr Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study
title_full_unstemmed Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study
title_short Provider-Identified Deprescribing Facilitators and Strategies for Older Adults in Primary Care: A Team Alice Study
title_sort provider-identified deprescribing facilitators and strategies for older adults in primary care: a team alice study
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740390/
http://dx.doi.org/10.1093/geroni/igaa057.1209
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