School of Healthcare, University of Leeds, Leeds, UK.
School of Pharmacy, Newcastle University, Newcastle, UK.
BMC Geriatr. 2024 Oct 16;24(1):844. doi: 10.1186/s12877-024-05435-x.
The process of identifying and discontinuing medicines in instances in which harms outweigh benefits (deprescribing) can mitigate the negative consequences of problematic polypharmacy. This process should be conducted with a focus on the patient and involve collaborative decision-making. Evidence is needed regarding patients' views on how deprescribing should be safely and routinely implemented in English primary care to improve its application. This study aimed to identify optimal methods of introducing and actioning deprescribing from the patient's perspective.
Participants in England aged 65 and above who were taking five or more medicines and residing in their own homes were recruited through social media and service user groups. An interview guide was created from deprescribing literature and input from patients and the public, guided by the Normalisation Process Theory (NPT). The interviews were held online using Microsoft Teams or via phone, recorded, and then transcribed. The data was analysed using the Framework analysis.
Twenty patients (mean age of 74.5, SD = 6.93), with 75% being female, were enrolled in the study. Three main themes emerged: (1) 'Why deprescribe now?' emphasised the significance of explaining the reasons behind deprescribing; (2) 'Monitoring and follow-up' underscored the necessity of safety measures during deprescribing and patients' willingness to self-monitor post-intervention; (3) 'Roles and relationships' explored patient perceptions of various healthcare professionals involved in deprescribing and the essential interpersonal skills for fostering therapeutic relationships.
Optimal methods of introducing deprescribing included communicating a convincing rationale for stopping medicines and preparing patients for deprescribing conversations. Patients required support from a range of healthcare professionals with whom they had an existing therapeutic relationship. Whilst patients were motivated to self-monitor unwanted/unexpected effects post-deprescribing, timely support was required. The nature of such bolstered collective action and cognitive participation within NPT enhances the normalisation potential of deprescribing. These findings highlight the significance of considering the content and process of deprescribing consultations to enhance normalisation and tackle problematic polypharmacy. This provides a deeper understanding of patients' needs for implementing safe and routine deprescribing in primary care, which should be considered when designing medication review and deprescribing services.
识别和停止危害大于益处的药物（撤药）的过程可以减轻多药治疗带来的负面影响。这个过程应该以患者为中心，涉及协作决策。需要了解患者对如何在英国初级保健中安全和常规实施撤药以改善其应用的看法。本研究旨在从患者的角度确定引入和实施撤药的最佳方法。
通过社交媒体和服务用户群体招募了年龄在 65 岁及以上、服用五种或更多药物且居住在自己家中的英格兰患者。采访指南是根据撤药文献和患者和公众的意见创建的，以正常化过程理论 (NPT) 为指导。采访在 Microsoft Teams 在线或通过电话进行，录音并转录。使用框架分析对数据进行分析。
研究共纳入 20 名患者（平均年龄 74.5 岁，标准差=6.93），其中 75%为女性。研究结果主要有三个主题：（1）“为何现在撤药？”强调了解释撤药原因的重要性；（2）“监测和随访”强调了撤药过程中的安全措施的必要性以及患者在干预后愿意自我监测；（3）“角色和关系”探讨了患者对参与撤药的各种医疗保健专业人员的看法以及促进治疗关系的必要人际交往技巧。
引入撤药的最佳方法包括沟通停止用药的令人信服的理由并为撤药对话做好准备。患者需要得到他们与之有现有治疗关系的一系列医疗保健专业人员的支持。尽管患者有动机在撤药后自行监测不必要/意外的效果，但需要及时提供支持。这种增强的集体行动和认知参与的性质在 NPT 中增强了撤药的正常化潜力。这些发现强调了考虑撤药咨询的内容和过程以增强正常化和解决多药治疗问题的重要性。这深入了解了患者在初级保健中实施安全和常规撤药的需求，在设计药物审查和撤药服务时应考虑这些需求。
