University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, South Australia, Australia; School of Pharmacy, Plein Center for Geriatric Research, Education and Outreach, University of Washington, Seattle, WA, USA.
University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, South Australia, Australia; University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
Patient Educ Couns. 2022 Mar;105(3):615-624. doi: 10.1016/j.pec.2021.06.021. Epub 2021 Jun 24.
To examine older adults' perceptions and identify barriers and enablers to initiating a conversation about stopping medication(s) with their healthcare provider.
We conducted one focus group (n = 3) and in-depth, face-to-face, individual interviews (n = 6) using an interview guide. Older adults aged ≥65 years in a retirement community who were taking ≥5 medications were recruited. Focus groups and interviews were audio-recorded and transcribed verbatim. Both a deductive analysis, informed by the Theoretical Domains Framework, and an inductive analysis were conducted.
Five themes and fourteen sub-themes were identified. Theme 1, 'older adult-related barriers', discusses limited or varying self-efficacy, past unsuccessful deprescribing experiences and limited familiarity with medications/deprescribing. Theme 2, 'provider-related barriers', discusses trust, short office visits, lack of communication and multiple providers. Theme 3, 'environmental/social-related barriers', involves limited availability of resources and access to telehealth/internet. The remaining themes (Themes 4-5) identified enablers including strategies to promote older adults' self-efficacy and improved healthcare communication.
Consumer-centric tools could improve older adults' self-efficacy to initiate deprescribing conversations.
Removing barriers and implementing enablers may empower older adults to initiate deprescribing conversations with providers to take fewer medications. Ultimately, this could be a catalyst for increased translation of deprescribing in practice.
探讨老年人对与医疗保健提供者讨论停止用药的看法，以及识别其障碍和促进因素。
我们采用访谈指南，进行了一次焦点小组（n=3）和六次深入的面对面个人访谈。研究对象为退休社区中≥65 岁、正在服用≥5 种药物的老年人。对焦点小组和访谈进行了录音，并逐字转录。采用理论领域框架进行演绎分析和归纳分析。
确定了五个主题和十四个子主题。主题 1“与老年人相关的障碍”讨论了自我效能感有限或不同、过去减药不成功的经历以及对药物/减药的了解有限。主题 2“与提供者相关的障碍”讨论了信任、就诊时间短、沟通不足和多个提供者。主题 3“环境/社会相关障碍”涉及资源有限和远程医疗/互联网获取受限。其余主题（主题 4-5）确定了促进因素，包括增强老年人自我效能感和改善医疗保健沟通的策略。
以消费者为中心的工具可以提高老年人启动减药对话的自我效能感。
消除障碍和实施促进因素可能使老年人有能力与提供者启动减药对话，减少用药量。最终，这可能成为推动实践中更多减药措施的催化剂。
