TY - JOUR
T1 - Challenges in Deprescribing among Older Adults in Post-Acute Care Transitions to Home
AU - Wang, Jinjiao
AU - Shen, Jenny Y.
AU - Yu, Fang
AU - Nathan, Kobi
AU - Caprio, Thomas V.
AU - Conwell, Yeates
AU - Moskow, Marian S.
AU - Brasch, Judith D.
AU - Simmons, Sandra F.
AU - Mixon, Amanda S.
AU - Norton, Sally A.
N1 - Publisher Copyright:
© 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2024/1
Y1 - 2024/1
N2 - Objectives: Medications with a higher risk of harm or that are unlikely to be beneficial are used by nearly all older patients in home health care (HHC). The objective of this study was to understand stakeholders’ perspectives on challenges in deprescribing these medications for post-acute HHC patients. Design: Qualitative individual interviews were conducted with stakeholders involved with post-acute deprescribing. Setting and Participant: Older HHC patients, HHC nurses, pharmacists, and primary/acute care/post-acute prescribers from 9 US states participated in individual qualitative interviews. Measures: Interview questions were focused on the experience, processes, roles, training, workflow, and challenges of deprescribing in hospital-to-home transitions. We used the constant comparison approach to identify and compare findings among patient, prescriber, and pharmacist and HHC nurse stakeholders. Results: We interviewed 9 older patients, 11 HHC nurses, 5 primary care physicians (PCP), 3 pharmacists, 1 hospitalist, and 1 post-acute nurse practitioner. Four challenges were described in post-acute deprescribing for HHC patients. First, PCPs' time constraints, the timing of patient encounters after hospital discharge, and the lack of prioritization of deprescribing make it difficult for PCPs to initiate post-acute deprescribing. Second, patients are often confused about their medications, despite the care team's efforts in educating the patients. Third, communication is challenging between HHC nurses, PCPs, specialists, and hospitalists. Fourth, the roles of HHC nurses and pharmacists are limited in care team collaboration and discussion about post-acute deprescribing. Conclusions and Implications: Post-acute deprescribing relies on multiple parties in the care team yet it has challenges. Interventions to align the timing of deprescribing and that of post-acute care visits, prioritize deprescribing and allow clinicians more time to complete related tasks, improve medication education for patients, and ensure effective communication in the care team with synchronized electronic health record systems are needed to advance deprescribing during the transition from hospital to home.
AB - Objectives: Medications with a higher risk of harm or that are unlikely to be beneficial are used by nearly all older patients in home health care (HHC). The objective of this study was to understand stakeholders’ perspectives on challenges in deprescribing these medications for post-acute HHC patients. Design: Qualitative individual interviews were conducted with stakeholders involved with post-acute deprescribing. Setting and Participant: Older HHC patients, HHC nurses, pharmacists, and primary/acute care/post-acute prescribers from 9 US states participated in individual qualitative interviews. Measures: Interview questions were focused on the experience, processes, roles, training, workflow, and challenges of deprescribing in hospital-to-home transitions. We used the constant comparison approach to identify and compare findings among patient, prescriber, and pharmacist and HHC nurse stakeholders. Results: We interviewed 9 older patients, 11 HHC nurses, 5 primary care physicians (PCP), 3 pharmacists, 1 hospitalist, and 1 post-acute nurse practitioner. Four challenges were described in post-acute deprescribing for HHC patients. First, PCPs' time constraints, the timing of patient encounters after hospital discharge, and the lack of prioritization of deprescribing make it difficult for PCPs to initiate post-acute deprescribing. Second, patients are often confused about their medications, despite the care team's efforts in educating the patients. Third, communication is challenging between HHC nurses, PCPs, specialists, and hospitalists. Fourth, the roles of HHC nurses and pharmacists are limited in care team collaboration and discussion about post-acute deprescribing. Conclusions and Implications: Post-acute deprescribing relies on multiple parties in the care team yet it has challenges. Interventions to align the timing of deprescribing and that of post-acute care visits, prioritize deprescribing and allow clinicians more time to complete related tasks, improve medication education for patients, and ensure effective communication in the care team with synchronized electronic health record systems are needed to advance deprescribing during the transition from hospital to home.
KW - Home health care
KW - deprescribing
KW - polypharmacy
KW - transitions of care
UR - http://www.scopus.com/inward/record.url?scp=85178137722&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85178137722&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2023.09.021
DO - 10.1016/j.jamda.2023.09.021
M3 - Article
C2 - 37913819
AN - SCOPUS:85178137722
SN - 1525-8610
VL - 25
SP - 138-145.e6
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 1
ER -