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Gerontologist. 2019 Aug 21. pii: gnz116. doi: 10.1093/geront/gnz116. [Epub ahead of print]

"… Above All, It's a Matter of  This Person's Quality of Life": Health Care Professionals' Perspectives on Deprescribing in Older Patients With Limited Life Expectancy.

Author information

1
Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.
2
OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark.
3
Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C.
4
Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark.
5
Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense C.
6
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C.
7
Migrant Health Clinic, Odense University Hospital, Odense C, Denmark.
8
Centre for Global Health, University of Southern Denmark, Odense C.
9
Health Sciences Research Center, University College Lillebælt, Odense M, Denmark.

Abstract

BACKGROUND AND OBJECTIVES:

Deprescribing may be particularly relevant in older people with limited life expectancy. In order to effectively carry out deprescribing in this population, it is important to understand the perspectives of the full spectrum of health care professionals (HCPs) involved in the management of these patients' medication. Thus, we aimed to explore different HCPs' perspectives on deprescribing in older patients with limited life expectancy.

RESEARCH DESIGN AND METHODS:

Six qualitative focus group interviews were conducted using a semistructured approach. The groups comprised HCPs from both primary and secondary care, including family physicians (FPs), geriatricians, clinical pharmacologists, clinical pharmacists, nurses, and health care assistants. Interviews were audio recorded and transcribed verbatim. Results were analyzed using systematic text condensation.

RESULTS:

A total of 32 HCPs participated in the study (median age of 40.5 years; 22% male). The analysis elicited three main themes related to HCPs' perspectives on deprescribing in older patients with limited life expectancy: (a) Approaching deprescribing, (b) Taking responsibility, and (c) Collaboration across professions. Within themes, subthemes were identified and analyzed.

DISCUSSION AND IMPLICATIONS:

Our results imply that different groups of HCPs consider deprescribing an essential aspect of providing good care for older people with limited life expectancy and find that all HCPs play a crucial role in the deprescribing process, with FPs having the primary responsibility. In order to facilitate deprescribing among this population, however, the collaboration between different HCPs should be improved.

KEYWORDS:

Deprescription; End of life care; Focus groups; Frailty; Qualitative research methods

PMID:
31433836
DOI:
10.1093/geront/gnz116

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