Warmoth Krystal, Rees Jessica, Day Jo, Cockcroft Emma, Aylward Alex, Pollock Lucy, Coxon George, Craig Trudy, Walton Bridget, Stein Ken
Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK; National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK.
Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK; National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK.
Res Social Adm Pharm. 2024 Apr;20(4):379-388. doi: 10.1016/j.sapharm.2023.11.008. Epub 2023 Dec 16.
Care home residents often experience polypharmacy (defined as taking five or more regular medicines). Therefore, we need to ensure that residents only take the medications that are appropriate or provide value (also known as medicines optimisation). To achieve this, deprescribing, or the reduction or stopping of prescription medicines that may no longer be providing benefit, can help manage polypharmacy and improve outcomes. Various tools, guides, and approaches have been developed to help support health professionals to deprescribe in regular practice. Little evaluation of these tools has been conducted and no work has been done in the care home setting.
This qualitative study aimed to assess distinct types of deprescribing tools for acceptability, feasibility, and suitability for the care home setting.
Cognitive (think-aloud) interviews with care home staff in England were conducted (from December 2021 to June 2022) to assess five different deprescribing tools. The tools included a general deprescribing guidance, a generic (non-drug specific) deprescribing framework, a drug-specific deprescribing guideline/guide, a tool for identifying potentially inappropriate medications, and an electronic clinical decision support tool. Participants were recruited via their participation in another deprescribing study. The Consolidated Framework for Implementation Research informed the data collection and analysis.
Eight care home staff from 7 different care homes were interviewed. The five deprescribing tools were reviewed and assessed as not acceptable, feasible, or suitable for the care home setting. All would require significant modifications for use in the care home setting (e.g., language, design, and its function or use with different stakeholders).
As none of the tools were deemed acceptable, feasible, and suitable, future work is warranted to develop and tailor deprescribing tools for the care home setting, considering its specific context and users. Deprescribing implemented safely and successfully in care homes can benefit residents and the wider health economy.
养老院居民经常服用多种药物（定义为服用五种或更多常规药物）。因此，我们需要确保居民只服用合适的或有价值的药物（也称为药物优化）。为实现这一目标，减药，即减少或停用可能不再有益的处方药，有助于管理多重用药并改善结果。已经开发了各种工具、指南和方法来帮助支持卫生专业人员在日常实践中进行减药。对这些工具的评估很少，并且在养老院环境中尚未开展相关工作。
这项定性研究旨在评估不同类型的减药工具在养老院环境中的可接受性、可行性和适用性。
（2021年12月至2022年6月）对英格兰养老院工作人员进行了认知（出声思考）访谈，以评估五种不同的减药工具。这些工具包括一般减药指南、通用（非特定药物）减药框架、特定药物减药指南、识别潜在不适当药物的工具以及电子临床决策支持工具。通过参与另一项减药研究招募参与者。实施研究综合框架为数据收集和分析提供了指导。
对来自7个不同养老院的8名养老院工作人员进行了访谈。这五种减药工具经审查和评估，被认为不适合养老院环境，不可接受且不可行。所有工具都需要进行重大修改才能在养老院环境中使用（例如，语言、设计及其功能或与不同利益相关者的使用方式）。
由于没有一种工具被认为是可接受、可行和合适的，因此有必要开展未来工作，考虑到养老院的具体情况和用户，为养老院环境开发和定制减药工具。在养老院安全、成功地实施减药可以使居民和更广泛的卫生经济受益。
