Lisa Kouladjian1, Danijela Gnjidic2, Emily Reeve3, Timothy F Chen4, Sarah N Hilmer5. 1. Kolling Institute of Medical Research, St Leonards, NSW, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia lisa.kouladjian@sydney.edu.au. 2. Kolling Institute of Medical Research, St Leonards, NSW, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia. 3. Kolling Institute of Medical Research, St Leonards, NSW, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia Faculty of Medicine, Dalhousie University, Nova Scotia, Canada. 4. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia. 5. Kolling Institute of Medical Research, St Leonards, NSW, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Abstract
BACKGROUND: Anticholinergic and sedative (ACh-Sed) medications are commonly prescribed for older adults and are associated with adverse events. OBJECTIVES: (1) To investigate perspectives of health care practitioners (HCPs) surrounding deprescribing (withdrawal) of ACh-Sed medications in older adults; (2) to assess HCPs' perspectives on the design and implementation of a report on a patient's exposure to ACh-Sed medications using the Drug Burden Index (DBI) pharmacological tool. METHODS: This was a qualitative study using focus groups with purposive samples of accredited pharmacists (APs), general practitioners (GPs), and specialist physicians (SPs). Participants were also asked to comment on a sample DBI report of a hypothetical patient and its potential role in practice. The discussions were audiorecorded, transcribed verbatim, and thematically analyzed to derive conceptual domains. QSR NVivo Version 10 was used for data management. RESULTS: Several barriers and enablers to deprescribing ACh-Sed medications in older adults were identified. The most noteworthy barrier to deprescribing related to devolving responsibility. Predominantly, APs expressed frustration surrounding disregard by GPs of their recommendations to deprescribe medications. GPs expressed that deprescribing should be conducted by SPs and vice versa. The DBI report supported and addressed some of the identified barriers to deprescribing ACh-Sed medications in older adults. The HCPs also identified several opportunities and considerations for implementing the DBI report in practice, mainly highlighting that ACh-Sed medications are not the only high-risk medications for older people. CONCLUSIONS: Although HCPs recognize the harms associated with ACh-Sed medication use, they devolve prescribing and management responsibility to other groups of HCPs.
BACKGROUND: Anticholinergic and sedative (ACh-Sed) medications are commonly prescribed for older adults and are associated with adverse events. OBJECTIVES: (1) To investigate perspectives of health care practitioners (HCPs) surrounding deprescribing (withdrawal) of ACh-Sed medications in older adults; (2) to assess HCPs' perspectives on the design and implementation of a report on a patient's exposure to ACh-Sed medications using the Drug Burden Index (DBI) pharmacological tool. METHODS: This was a qualitative study using focus groups with purposive samples of accredited pharmacists (APs), general practitioners (GPs), and specialist physicians (SPs). Participants were also asked to comment on a sample DBI report of a hypothetical patient and its potential role in practice. The discussions were audiorecorded, transcribed verbatim, and thematically analyzed to derive conceptual domains. QSR NVivo Version 10 was used for data management. RESULTS: Several barriers and enablers to deprescribing ACh-Sed medications in older adults were identified. The most noteworthy barrier to deprescribing related to devolving responsibility. Predominantly, APs expressed frustration surrounding disregard by GPs of their recommendations to deprescribe medications. GPs expressed that deprescribing should be conducted by SPs and vice versa. The DBI report supported and addressed some of the identified barriers to deprescribing ACh-Sed medications in older adults. The HCPs also identified several opportunities and considerations for implementing the DBI report in practice, mainly highlighting that ACh-Sed medications are not the only high-risk medications for older people. CONCLUSIONS: Although HCPs recognize the harms associated with ACh-Sed medication use, they devolve prescribing and management responsibility to other groups of HCPs.
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