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Primary care clinicians’ use of deprescribing recommendations: A mixed-methods study
Institution:1. Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave., #240, West Haven, CT 06516, USA;2. Program on Aging, Yale School of Medicine, 300 George St., New Haven, CT 06511, USA;3. Department of Medicine, Yale School of Medicine, 333 Cedar St., New Haven, CT 06520, USA;1. Department of Medicine, Cooper University Hospital, Camden, NJ, USA;2. Department of Urology, Indiana Health University Hospital, Indianapolis, IN, USA;1. School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia;2. Centre for Health Systems and Safety Research (CHSSR), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia;3. The University of Melbourne, Melbourne School of Health Sciences, Melbourne, Australia;4. School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia;5. School of Public Health, The University of Sydney, New South Wales, Australia;1. Amsterdam University Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, the Netherlands;2. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA;1. St. Mary’s Research Centre, 3830 Lacombe Ave., Hayes Pavilion, Suite 4720, Montreal H3T 1M5, Quebec, Canada;2. Montreal West Island Integrated University Health and Social Services Centre, 3830 Lacombe Ave., Montreal H3T 1M5, Quebec, Canada;3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave, Montreal, Quebec H3A 1A2, Canada;4. Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, Quebec H3S 1Z1, Canada;5. Department of Family Medicine, St. Mary’s Hospital Center, 3830 Lacombe Ave, Hayes Pavilion, Montreal H3T 1M5, Quebec, Canada;6. Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada;7. Département de radio-oncologie, Centre hospitalier de l’Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada;8. Ingram School of Nursing, McGill University, 80 Sherbrooke St W, Suite1800, Montreal, Quebec H3A 2M7, Canada;9. Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto M5G 2C1, Ontario, Canada;1. Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;2. Department of Psychology, Wake Forest University, Winston-Salem, North Carolina, USA;3. Division of Nursing, School of Health Sciences, Winston-Salem State University, Winston-Salem, North Carolina, USA;4. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;5. Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;6. Department of Dermatology, University of Southern Denmark, Odense, Denmark
Abstract:Objectiveto explore the effects of a deprescribing intervention on primary care clinicians’ medication-related communication.MethodsA clinical decision support tool provided clinicians in the intervention group with an individualized report regarding potentially inappropriate medications (PIMs), deintensification of diabetes and/or hypertension treatment, and poor adherence/cognition. Participants included 113 Veterans aged ≥ 65 prescribed ≥ 7 medications and their primary care clinicians. Encounters were recorded and analyzed.ResultsBetween 36% and 38% of intervention clinicians discussed PIMs and diabetes mellitus/hypertension deintensification and 94% discussed adherence. PIMs discussions referred to the report and prompted some medication changes. The diabetes mellitus/hypertension and adherence discussions were not prompted by the report but instead arose from enhanced medication reconciliation. Changes in diabetes mellitus/hypertension medications were not made out of overtreatment concerns. There was no deprescribing for nonadherence. Enhanced medication reconciliation also led to discussions about medications not in the report.ConclusionAn individualized report regarding medication appropriateness prompted clinicians to perform a more thorough medication reconciliation and discuss PIMs. It did not prompt chronic care deintensification or deprescribing to enhance adherence.Practice ImplicationsFeedback reports can promote robust medication reconciliation in primary care. Changing clinician practice to achieve deprescribing in chronic disease management will be more challenging.
Keywords:Deprescribing  Patient-provider communication  Polypharmacy  Primary care
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