Patients' attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists.
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ABSTRACT:
SUBMITTER: Lukacena KM
PROVIDER: S-EPMC9393353 | biostudies-literature | 2022
REPOSITORIES: biostudies-literature
Publications
Patients' attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists.
Lukacena Kaylee M KM Keck James W JW Freeman Patricia R PR Harrington Nancy Grant NG Huffmyer Mark J MJ Moga Daniela C DC
Therapeutic advances in drug safety 20220819
<h4>Purpose</h4>Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients' beliefs and attitudes and identify facilitators of and barriers to deprescribing.<h4>Methods</h4>As part of a larger study, we recruited patients ⩾18 years of age taking ⩾3 ch ...[more]
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Project description:ImportanceBetter understanding of patients' attitudes toward deprescribing specific medications will inform future deprescribing interventions.ObjectiveTo investigate older adults' attitudes toward deprescribing by investigating which medications they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing.Design, setting, and participantsThis survey study was conducted from May 2022 to December 2023 in primary care settings in 14 countries. Patients aged 65 years or older taking 5 or more medications were consecutively recruited by their general practitioner (GP) and completed the questionnaire.ExposuresPatient characteristics, including gender, number of medications, GP gender, education level, financial status, confidence in completing medical forms, self-rated health, satisfaction with medications, trust in the GP, and country.Main outcomes and measuresThe primary outcomes were patient attitudes toward deprescribing specific medications, as measured by responses to the question, "Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?" Multilevel multivariable logistic regression analysis was used, adjusted for clustering effect at the country level, to investigate the association between patient characteristics and interest in deprescribing.ResultsOf 1340 patients (mean [SD], 96 [47] patients per country), 736 (55%) were women, 580 (44%) had secondary school as their highest level of education, 1089 (82%) were satisfied with their medications, and 589 (44%) expressed they would like to deprescribe 1 or more of their medications. Patients expressed interest in deprescribing specific medications at varying levels, from 79% (86 of 109 patients) in Poland to 23% (21 of 96 patients) in Bulgaria. The 3 most reported medications patients would like to have deprescribed were diuretics (111 of 1002 medications [11%]), lipid-modifying agents (109 of 1002 medications [11%]), and agents acting on the renin-angiotensin system (83 of 1002 medications [8%]). The odds of naming at least 1 specific medication for deprescribing were lower for patients with higher medication satisfaction (odds ratio, 0.31; 95% CI, 0.21-0.47) and for patients with higher trust in their GP (odds ratio, 0.960; 95% CI, 0.930-0.998).Conclusions and relevanceIn this survey study with primary care patients aged 65 years and older, patient attitudes toward deprescribing specific medications varied across countries, demonstrating that deprescribing interventions could be more impactful when adapted to specific settings and contexts. These findings highlight the importance of patient-practitioner communication in ensuring appropriate medication use.
| S-EPMC11811803 | biostudies-literature
Project description:BackgroundAustralian pharmacists currently dispense a wide range of prescription-only cannabis-based medicines. Recent regulatory changes will expand the role of pharmacists, allowing certain low-dose cannabidiol products to be supplied without a prescription in pharmacies. This harmonises Australia with many other countries where cannabidiol products are readily available to consumers.AimTo examine Australian pharmacists' experience, knowledge and attitudes towards medicinal cannabis and their preparedness to supply over-the-counter low-dose cannabidiol products.MethodWe conducted a cross-sectional study using a 51-item on-line questionnaire that was informed by previous surveys of health professionals and assessed for face validity. Australian pharmacists were recruited to complete the survey between May and December 2021, primarily through professional pharmacy organisations. Pharmacists were included in the final dataset if they completed the demographic characteristics section and at least one additional section of the questionnaire. Data were analysed using descriptive and relational statistical tests.ResultsThere were 272 attempts to complete this survey and 217 responses included in the final dataset. Over half of the respondents (60.0%, 130/217) had dispensed at least one medicinal cannabis prescription during their career and 58.5% (127/217) had received at least one medicinal cannabis enquiry in the last fortnight. Only around half (53.9%, 117/217) felt comfortable supplying medicinal cannabis products and fewer (39.3%, 79/201) were confident discussing cannabis-related enquiries. More than half of the respondents (58.7%, 118/201) supported the provision of low-dose cannabidiol products through pharmacies. Two-thirds (67.8%, 80/118) of respondents achieved relatively low scores (< 60%) in the knowledge component of the survey. Most respondents (94.2%, 178/189) endorsed a need for further training in this area.ConclusionAustralian pharmacists tended to support medicinal cannabis availability and improved access to low-dose cannabidiol products via pharmacies. However, results highlight a need for improved training and education of pharmacists around cannabis-based medicines.
| S-EPMC9708126 | biostudies-literature
Project description:BackgroundOpioids and benzodiazepines (BZDs) pose a public health problem. Older adults are especially susceptible to adverse events from opioids and BZDs owing to an increased usage of opioids and BZDs, multiple comorbidities, and polypharmacy. Deprescribing is a possible, yet challenging, solution to reducing opioid and BZD use.ObjectiveWe aimed to explore older adult patients' knowledge of opioids and BZDs, perceived facilitators and barriers to deprescribing opioids and BZDs, and attitudes toward alternative treatments for opioids and BZDs.MethodsWe conducted 11 semi-structured interviews with patients aged 65+ years with long-term opioid and/or BZD prescriptions. The interview guide was developed by an interprofessional team and focused on patients' knowledge of opioids and BZDs, perceived ability to reduce opioid or BZD use, and attitudes towards alternative treatments.ResultsThree patients had taken opioids, either currently or in the past, three had taken BZDs, and five had taken both opioids and BZDs. Generally, knowledge of opioids and BZDs was variable among patients; yet facilitators and barriers to deprescribing both opioids and BZDs were consistent. Facilitators of deprescribing included patient-provider trust and slow tapering of medications, while barriers included concerns about re-emergence of symptoms and a lack of motivation, particularly if medications and symptoms were stable. Patients were generally unenthusiastic about pursuing alternative pharmacologic and non-pharmacologic alternatives to opioids and BZDs for symptom management.ConclusionsOur findings indicate that patients are open to deprescribing opioids and BZDs under certain circumstances, but overall remain hesitant with a lack of enthusiasm for alternative treatments. Future studies should focus on supportive approaches to alleviate older adults' deprescribing concerns.
| S-EPMC10768261 | biostudies-literature
Project description:BackgroundPatients' attitudes toward deprescribing are crucial to understand before developing interventions, but no such data exists in the medically underserved, health disparities population of rural Appalachian United States.Objective(s)Assess Appalachian women's openness to deprescribing medications and determine if polypharmacy influenced their attitudes toward deprescribing.MethodsBefore and after a cognitive behavioral therapy intervention, middle-aged Appalachian women self-reported medication use and completed the revised Patients' Attitudes Toward Deprescribing Questionnaire (rPATD). Responses were described, stratified by presence of polypharmacy.Results30 women completed the rPATD pre- and post-intervention (mean [SD] age 55.8 [6.6] years; 96.7% white). Those with polypharmacy (n = 16) had higher burden and involvement scores (median 2.8 vs 2.0, p = 0.01; 4.9 vs 4.6, p = 0.06), and lower appropriateness scores (3.4 vs 3.9, p = 0.04). Burden, concerns about stopping, and involvement factor scores were similar before and after the intervention (p = 0.08, 0.86, and 0.41 respectively). ≥90% of participants were satisfied with their current medications yet would be willing to stop one or more.ConclusionsMiddle-aged women in rural Appalachian United States are open to deprescribing; polypharmacy is associated with lower belief in the appropriateness of medications. Larger studies are needed to inform future deprescribing interventions for this and other similarly disadvantaged populations.
| S-EPMC7483264 | biostudies-literature
Project description:Although pharmacy literature suggests that pharmacists have a positive attitude towards older adults, there is a paucity of studies that have measured pharmacists' knowledge or attitudes towards older people. The purpose of our study was to assess the knowledge and attitudes of hospital pharmacists toward older adults. An electronic survey was distributed over two months to clinical hospital pharmacists across the province of Alberta, Canada. The survey was composed of two validated tools, the Palmore Facts of Aging Quiz (PFAQ) and Kogan's Attitude toward Old People Scale (KOPS). PFAQ is scored from 0 (poor knowledge) to 25 (high knowledge) and KOPS from 34 to 204, with higher than 119 indicating a positive attitude. A total of 153 pharmacists completed the survey (response rate of 24%). The mean age was 39 (SD 10.8) years; the average years practiced was 15 (SD 11), and the majority of respondents (n = 65) reported that >50% of patients in their practice were geriatrics. The mean correct responses on the PFAQ were 18.8 (SD 2.6). KOPS had a mean score of 156.8 (SD 14), with only one pharmacist score falling below 119, indicating a negative attitude. There was a statistically significant, positive correlation between attitudes and knowledge (r = 0.38, p < 0.05), as well as the increasing age of the respondents (r = 0.18, p = 0.03). The remaining measured categories (i.e., gender, years of pharmacy practice) had no significant effect. Clinical hospital pharmacists in Alberta have a positive attitude toward geriatric patients, as well as a satisfactory knowledge of older adults.
| S-EPMC8544685 | biostudies-literature
Project description:To describe communication experiences of surrogates who had recently made a major medical decision for a hospitalized older adult.Semistructured interviews about a recent hospitalization.Two hospitals affiliated with one large medical school: an urban public hospital and a university-affiliated tertiary referral hospital.Surrogates were eligible if they had recently made a major medical decision for a hospitalized individual aged 65 and older and were available for an interview within 1 month (2-5 months if the patient died).Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory.Thirty-five surrogates were interviewed (80% female, 44% white, 56% African American). Three primary themes emerged. First, it was found that the nature of surrogate-clinician relationships was best characterized as a relationship with a "team" of clinicians rather than individual clinicians because of frequent staff changes and multiple clinicians. Second, surrogates reported their communication needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described trust and mistrust, which were formed largely through surrogates' communication experiences.In the hospital, surrogates form relationships with a "team" of clinicians rather than with individuals, yet effective communication and expressions of emotional support frequently occur, which surrogates value highly. Future interventions should focus on meeting surrogates' needs for frequent communication and high levels of information and emotional support.
| S-EPMC3683825 | biostudies-literature
Project description:BackgroundPeople with dementia (PWD) take medications that may be unnecessary or harmful. This problem can be addressed through deprescribing, but it is unclear if PWD would be willing to engage in deprescribing with their providers. Our goal was to investigate attitudes toward deprescribing among PWD.MethodsThis was a cross-sectional study of 422 PWD aged ≥65 years who completed the medications attitudes module of the National Health and Aging Trends Study (NHATS) in 2016. Proxies provided responses when a participant was unable to respond due to health or cognitive problems. Attitudinal outcomes comprised responses to two statements from the patients' attitudes toward deprescribing questionnaire and its revised version (representing belief about the necessity of one's medications and willingness to deprescribe); another elicited the maximum number of pills that a respondent would be comfortable taking.ResultsThe weighted sample represented over 1.8 million PWD; 39% were 75 to 84 years old and 38% were 85 years or older, 60% were female, and 55% reported six or more regular medications. Proxies provided responses for 26% of PWD. Overall, 22% believed that they may be taking one or more medicines that they no longer needed, 87% were willing to stop one or more of their medications, and 50% were uncomfortable taking five or more medications. Attitudinal outcomes were similar across sociodemographic and clinical factors. PWD taking ≥6 medications were more likely to endorse a belief that at least one medication was no longer necessary compared to those taking <6 (adjusted probability 29% [95% confidence interval (CI), 22%-38%] vs. 13% [95% CI, 8%-20%]; p = 0.004); the same applied for willingness to deprescribe (92% [95% CI, 87%-95%] vs. 83% [95% CI, 76%-89%]; p = 0.04).ConclusionsA majority of PWD are willing to deprescribe, representing an opportunity to improve quality of life for this vulnerable population.
| S-EPMC9177826 | biostudies-literature
Project description:This study aimed to describe attitudes toward deprescribing among older adults and caregivers. We recruited 110 adults 65 years and above using at least one prescribed medication for at least 3 months, and 95 unrelated caregivers (18+) of older adults with such characteristics, who answered the validated French version of the revised Patients' Attitudes Towards Deprescribing questionnaire. More older adults (84.5%) than caregivers (70.5%) (p = .007) would be willing to stop at least one medication if the doctor said it was possible. Conversely, 93.5% of older adults and 78.9% of caregivers were satisfied with the current medications taken (p = .0024). The results did not vary according to age, sex, number of medications taken, education level, or residency. Thus, older adults and caregivers are disposed to undertake deprescribing, regardless of sociodemographic characteristics. However, relying solely on satisfaction with current medications may not be sufficient to identify relevant deprescribing opportunities.
| S-EPMC9024025 | biostudies-literature
Project description:(1) Background: Uptake of pharmacogenomic testing in routine clinical practices is currently slow in China. Pharmacists might play an important role in leveraging care through applying pharmacogenomics, therefore, it is important to better understand clinical pharmacists' knowledge of and attitudes toward pharmacogenomic testing, which has not been well-studied. (2) Methods: A self-administered survey was developed based on previous knowledge of pharmacogenomic testing and its uptake in China. Participants were recruited through the Committee of Pharmaceutical Affairs Management under the Chinese Hospital Association. (3) Results: A total of 1005 clinical pharmacists completed the questionnaire, among whom 996 (99.10%) had heard of pharmacogenomic testing before participation. More than half of respondents (60.0%, n = 597) rated their knowledge of pharmacogenomic testing as "average", while 25% rated it "good" or "excellent". "Guidelines, consensus and treatment paths for disease diagnosis and treatment" (78.7%) were the most preferred sources of information about pharmacogenomic testing. Most respondents (77.0%) believed that pharmacogenomics could "help to improve efficacy and reduce the incidence of adverse reactions". Our participants also believed that patients would benefit most from pharmacogenomic testing through better prediction of individual drug responses and thus informed treatment decisions. The top challenge for the uptake of pharmacogenomic testing was its high cost or lack of insurance coverage (76.7%). (4) Conclusions: Most Chinese clinical pharmacists who participated in our study had a positive attitude toward pharmacogenomic testing, while the knowledge of pharmacogenomic testing was generally self-assessed as average.
| S-EPMC9410027 | biostudies-literature
Project description:Background: Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide. In Japan, the spread of COVID-19 was recognized and a state of emergency declared in April 2020. In response, public health interventions, such as discouraging people from leaving their homes unnecessarily, were enacted across the country. Under these circumstances, telemedicine has received a great deal of social attention, and it has become necessary to identify the perceptions of and attitudes toward telemedicine by clinicians and patients and to clarify the problems and advantages. Materials and Methods: Ten clinicians and 10 family members (if the patient was pediatric or elderly, a caregiver was included) were invited to participate in individual private interviews in 2020. All interviews were conducted from October to December 2020 using a semistructured interview guide. All transcripts were coded using thematic content analysis. Results: Four categories from clinicians and five from patients were identified as perceptions of and attitudes toward telemedicine. Both evaluated the usefulness and convenience of telemedicine in the same manner, but there was a large gap in the content under the safety and problem categories. Discussion: It is necessary to disseminate information about the communication techniques unique to telemedicine to doctors and to improve the "operation and introduction" and "communication environment and device settings" when starting or using telemedicine for all patients. Conclusions: The perceptions and attitudes identified in this study will be useful for establishing and developing a telemedicine system in Japan.
| S-EPMC8812287 | biostudies-literature