Barricades and brickwalls--a qualitative study exploring perceptions of medication use and deprescribing in long-term care - PubMed (original) (raw)

Barricades and brickwalls--a qualitative study exploring perceptions of medication use and deprescribing in long-term care

Anna Palagyi et al. BMC Geriatr. 2016.

Abstract

Background: The co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse drug events in the older population, and residents of long-term care facilities (LTCFs) are at particularly high risk of medication harm. 'Deprescribing'--the withdrawal of an inappropriate medication with goal of managing polypharmacy and improving outcomes--may improve the quality of life of LTCF residents. The RELEASE study sought to explore perceptions of medication use and the concept of deprescribing in LTCFs.

Methods: Focus groups and interviews were conducted with General Practitioners (GPs), pharmacists, nursing staff, residents and their relatives within three LTCFs in the Illawarra-Shoalhaven region of NSW, Australia. Audiotapes were transcribed verbatim and, using the Integrative Model of Behaviour Prediction as a framework, thematic analysis of transcripts was conducted using QSR NVivo 10.

Results: Participants acknowledged the burden of too many medications (time to administer, physical discomfort, cost), yet displayed passivity towards medication reduction. Residents and relatives lacked understanding of medicine indications or potential harms. Willingness to initiate and accept medication change was dependent on the GP, who emerged as a central trusted figure. GPs preferred 'the path of least resistance', signalling systems barriers (poor uniformity of LTCF medical records, limited trained LTCF personnel); time constraints (resident consultations, follow-up with specialists and family); and the organisation of care (collaborating with LTCF staff, pharmacists and prescribing specialists) as obstacles to deprescribing.

Conclusions: Targeted engagement is required to raise awareness of the risks of polypharmacy in LTCFs and encourage acceptance of deprescribing amongst residents and their relatives. GPs are integral to the success of deprescribing initiatives within this sector.

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Figures

Fig. 1

Fig. 1

An Integrative Model of Behaviour Prediction, adapted from Fishbein (2006). Themes emerging from the analysis were most clearly associated with five key elements: environmental factors, attitudes, control beliefs and self-efficacy, and skills and abilities

Fig. 2

Fig. 2

Major themes (in bold) and intermediate coding framework (boxed) emerging from discussions about medication use and deprescribing in long-term care facilities with participants of the RELEASE study. GP general practitioner, f female, F facility, LTCF long-term care facility, m male, RN registered nurse, y years

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References

    1. Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-h snapshot of Australians aged 50 years and older. Med J Aust. 2012;196(1):50–3. doi: 10.5694/mja11.10698. - DOI - PubMed
    1. Cheek J, Gilbert A, Ballantyne A, Penhall R. Factors influencing the implementation of quality use of medicines in residential aged care. Drugs Aging. 2004;21(12):813–24. doi: 10.2165/00002512-200421120-00005. - DOI - PubMed
    1. Stafford AC, Alswayan MS, Tenni PC. Inappropriate prescribing in older residents of Australian care homes. Journal of Clinical Pharmacy & Therapeutics. 2011;36(1):33–44. doi: 10.1111/j.1365-2710.2009.01151.x. - DOI - PubMed
    1. Somers M, Rose E, Simmonds D, Whitelaw C, Calver J, Beer C. Quality use of medicines in residential aged care. Aust Fam Physician. 2010;39(6):413–6. - PubMed
    1. Khalil H. A review of pharmacist recommendations in an aged care facility. Aust J Prim Health. 2011;17(1):35–9. doi: 10.1071/PY10044. - DOI - PubMed

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