10.25905/5C2EE102C99E3
Turner, Justin Paul
Melinda Stanners
Susan Edwards
Sepehr Shakib
J. Simon Bell
What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals
<p><b>Objectives</b> Polypharmacy and multimorbidity are common in
long-term care facilities (LTCFs). Reducing polypharmacy may reduce adverse
events and maintain quality of life. Deprescribing refers to reducing
medications after consideration of therapeutic goals, benefits and risks, and
medical ethics. The objective was to use nominal group technique (NGT) to
generate then rank factors that general medical practitioners (GPs), nurses,
pharmacists and residents or their representatives perceive are most important
when deciding whether or not to deprescribe medications.<br></p>
<p><b>Design</b> Qualitative research using NGT.</p>
<p><b>Setting</b> Participants were invited if they worked with,
or resided in LTCFs across metropolitan and regional South Australia.</p>
<p><b>Participants</b> 11 residents/representatives, 19 GPs, 12 nurses
and 14 pharmacists participated across six separate groups.</p>
<p><b>Methods</b> Individual groups of GPs, nurses, pharmacists
and residents/representatives were convened. Using NGT each group ranked
factors perceived to be most important when deciding whether or not to
deprescribe. Then, using NGT, the prioritised factors from individual groups
were discussed and prioritised by a multidisciplinary metropolitan and regional
group comprised of resident representatives, GPs, nurses and pharmacists.</p>
<p><b>Results</b> No two groups had the same priorities. GPs
ranked ‘evidence for deprescribing’ and ‘communication with family/resident’ as
most important factors. Nurses ranked ‘GP receptivity to deprescribing’ and
‘nurses ability to advocate for residents’ as most important. Pharmacists
ranked ‘clinical appropriateness of therapy’ and ‘identifying residents’ goals
of care’ as most important. Residents ranked ‘wellbeing of the resident’ and
‘continuity of nursing staff’ as most important. The multidisciplinary groups
ranked ‘adequacy of medical and medication history’ and ‘identifying residents’
goals of care’ as most important.</p>
<p><b>Conclusions</b> While each group prioritised different factors,
common and contrasting factors emerged. Future deprescribing interventions need
to consider the similarities and differences within the range of factors
prioritised by residents and health professionals.</p><div>Perspectives of residents and health professionals. </div>BMJ Open 2016;6:e009781.<p> </p>
111709 Health Care Administration
111717 Primary Health Care
111702 Aged Health Care
Torrens University Australia
2019
2019-01-04
2019-01-04
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