Patient Perceptions of Deprescribing: Survey Development... : Medical Care (original) (raw)

Patient Centered Care

Survey Development and Psychometric Assessment

Linsky, Amy MD, MSc*,†,‡; Simon, Steven R. MD, MPH*,†,‡; Stolzmann, Kelly MS†; Meterko, Mark PhD§,∥

*Section of General Internal Medicine, VA Boston Healthcare System, Boston

†Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System and ENRM Veterans Affairs Medical Center, Boston and Bedford MA

‡Section of General Internal Medicine, Boston Medical Center, Boston

§Performance Measurement, VHA Office of Analytics and Business Intelligence, Bedford

∥Health Law, Policy and Management, Boston University School of Public Health, Boston, MA

A.L. was supported by a Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Career Development Award (CDA12-166), and the study was conducted using resources of the VA Boston Healthcare System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; nor the decision to submit the manuscript for publication.

Findings from this paper have been selected for oral presentation at the Society for General Internal Medicine annual meeting (Hollywood, FL, May 2016) and for poster presentation at the Academy Health annual research meeting (Boston, MA, June 2016).

The authors declare no conflict of interest.

Reprints: Amy Linsky, MD, MSc, General Internal Medicine (152G), VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. E-mail: [email protected].

Abstract

Background:

Although clinicians ultimately decide when to discontinue (deprescribe) medications, patients’ perspectives may guide the process.

Objectives:

To develop a survey instrument that assesses patients’ experience with and attitudes toward deprescribing.

Research Design:

We developed a questionnaire with established and newly created items. We used exploratory factor analysis and confirmatory factor analysis (EFA and CFA) to assess the psychometric properties.

Subjects:

National sample of 1547 Veterans Affairs patients prescribed ≥5 medications.

Measures:

In the EFA, percent variance, a scree plot, and conceptual coherence determined the number of factors. In the CFA, proposed factor structures were evaluated using standardized root mean square residual, root mean square error of approximation, and comparative fit index.

Results:

Respondents (n=790; 51% response rate) were randomly assigned to equal derivation and validation groups. EFA yielded credible 4-factor and 5-factor models. The 4 factors were “Medication Concerns,” “Provider Knowledge,” “Interest in Stopping Medicines,” and “Unimportance of Medicines.” The 5-factor model added “Patient Involvement in Decision-Making.” In the CFA, a modified 5-factor model, with 2 items with marginal loadings moved based upon conceptual fit, had an standardized root mean square residual of 0.06, an RMSEA of 0.07, and a CFI of 0.91. The new scales demonstrated internal consistency reliability, with Cronbach α’s of: Concerns, 0.82; Provider Knowledge, 0.86; Interest, 0.77; Involvement, 0.61; and Unimportance, 0.70.

Conclusions:

The Patient Perceptions of Deprescribing questionnaire is a novel, multidimensional instrument to measure patients’ attitudes and experiences related to medication discontinuation that can be used to determine how to best involve patients in deprescribing decisions.