Jungo Katharina Tabea, Choudhry Niteesh K, Marcantonio Edward R, Bhatkhande Gauri, Crum Katherine L, Haff Nancy, Hanken Kaitlin E, Lauffenburger Julie C
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Center for Healthcare Delivery Sciences, Department of Medicine and Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Gerontologist. 2025 Mar 25;65(4). doi: 10.1093/geront/gnaf028.
Care partners are critical for making treatment decisions in persons living with dementia. However, identifying them is challenging, hindering the broader use of interventions, such as those using digital technologies. We aimed to (i) assess the feasibility of identifying and contacting care partners using electronic health record (EHR) systems, and (ii) elicit their perspectives on electronic interventions for deprescribing.
We systematically identified care partners of persons living with dementia ≥65 years of age via structured EHR data in a large health care system. Eligible care partners were contacted by patient portal (if they were an established proxy), mail, and phone to complete a survey.
Of 4,138 eligible persons living with dementia identified, 1,084 (26%) had a care partner name recorded in the EHR. Out of 259 (6%) with sufficient care partner contact information for outreach, 74 (29%) completed the survey. Among care partners, 62 (84%) reported being confident in managing dementia medications, 59 (80%) were willing to stop ≥1 medications, and 43 (58%) were very/extremely interested in using digital tools for decision-making.
Despite the low percentage of care partners with sufficient contact information, reach rates were high for contacted care partners, suggesting feasibility for pragmatic system-level interventions. Most care partners showed great interest in using digital health tools for decision-making and managing medications. Therefore, electronic tools could help with identifying care partners and engaging them. However, scaling up interventions requires better care partner documentation or extracting information from free text.
护理伙伴对于痴呆症患者的治疗决策至关重要。然而，识别他们具有挑战性，这阻碍了诸如使用数字技术的干预措施的更广泛应用。我们旨在：（i）评估使用电子健康记录（EHR）系统识别和联系护理伙伴的可行性，以及（ii）了解他们对减药电子干预措施的看法。
我们通过一个大型医疗系统中的结构化EHR数据系统地识别了年龄≥65岁的痴呆症患者的护理伙伴。符合条件的护理伙伴通过患者门户网站（如果他们是已确定的代理人）、邮件和电话被联系以完成一项调查。
在识别出的4138名符合条件的痴呆症患者中，1084名（26%）在EHR中有护理伙伴姓名记录。在259名（6%）有足够护理伙伴联系信息以进行外展的患者中，74名（29%）完成了调查。在护理伙伴中，62名（84%）表示对管理痴呆症药物有信心，59名（80%）愿意停用≥1种药物，43名（58%）对使用数字工具进行决策非常/极其感兴趣。
尽管有足够联系信息的护理伙伴比例较低，但被联系的护理伙伴的回复率较高，这表明务实的系统层面干预措施具有可行性。大多数护理伙伴对使用数字健康工具进行决策和管理药物表现出极大兴趣。因此，电子工具有助于识别护理伙伴并让他们参与进来。然而，扩大干预措施需要更好地记录护理伙伴信息或从自由文本中提取信息。
