Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
J Am Geriatr Soc. 2023 Jan;71(1):62-76. doi: 10.1111/jgs.18047. Epub 2022 Oct 18.
As the population of older adults increases, appropriate deprescribing becomes increasingly important for emergency geriatric care. Older adults represent the sickest patients with chronic medical conditions, and they are often exposed to high-risk medications. We need to provide an evidence-based, standardized deprescribing program in the acute care setting, yet the evidence base is lacking and standardized medication programs are needed.
We conducted a qualitative study with the goal to understand the perspective of healthcare workers, patients, and caregivers on deprescribing high-risk medications in the context of emergency care practices, provider preferences, and practice variability, along with the facilitators and barriers to an effective deprescribing program in the emergency department (ED). To ensure rich, contextual data, the study utilized two qualitative methods: (1) a focus group with physicians, advanced practice providers, nurses, pharmacists, and geriatricians involved in care of older adults and their prescriptions in the acute care setting; (2) semi-structured interviews with patients and caregivers involved in treatment and emergency care. Transcriptions were coded using thematic content analysis, and the principal investigator (S.L.) and trained research staff categorized each code into themes.
Data collection from a focus group with healthcare workers (n = 8) and semi-structured interviews with patients and caregivers (n = 20) provided evidence of a potentially promising ED medication program, aligned with the vision of comprehensive care of older adults, that can be used to evaluate practices and develop interventions. We identified four themes: (1) Challenges in medication history taking, (2) missed opportunities in identifying high-risk medications, (3) facilitators and barriers to deprescribing recommendations, and (4) how to coordinate deprescribing recommendations.
Our focus group and semi-structured interviews resulted in a framework for an ED medication program to screen, identify, and deprescribe high-risk medications for older adults and coordinate their care with primary care providers.
随着老年人口的增加，适当的药物减量对于老年急诊护理变得越来越重要。老年人代表了患有慢性疾病的最病重患者，他们经常接触到高风险药物。我们需要在急性护理环境中提供基于证据的标准化药物减量计划，但目前证据不足，需要标准化的药物治疗计划。
我们进行了一项定性研究，旨在了解医疗保健工作者、患者和护理人员对在急诊护理实践、提供者偏好和实践变异性背景下，减少高危药物的看法，以及在急诊科实施有效药物减量计划的促进因素和障碍。为了确保获得丰富的背景数据，该研究采用了两种定性方法：（1）对参与照顾老年人及其急性护理处方的医生、高级执业护士、护士、药剂师和老年病学家进行焦点小组讨论；（2）对参与治疗和急诊护理的患者和护理人员进行半结构化访谈。使用主题内容分析法对转录内容进行编码，首席研究员（S.L.）和经过培训的研究人员将每个代码分类为主题。
对医疗保健工作者（n=8）的焦点小组和对患者和护理人员（n=20）的半结构化访谈的数据收集提供了一个有希望的急诊科药物治疗计划的证据，该计划符合全面照顾老年人的愿景，可以用于评估实践并制定干预措施。我们确定了四个主题：（1）药物史采集方面的挑战，（2）识别高危药物的机会错失，（3）药物减量建议的促进因素和障碍，以及（4）如何协调药物减量建议。
我们的焦点小组和半结构化访谈产生了一个急诊科药物计划框架，用于筛查、识别和减少老年人的高危药物，并与初级保健提供者协调他们的护理。
