Dataset Information

Unlocking Deprescribing Potential in Nursing Homes: Insights from a Focus Group Study with Healthcare Professionals.

ABSTRACT:

Background

The nursing home population is characterized by multimorbidity and disabilities, which often result in extensive prescription of medication and subsequent polypharmacy. Deprescribing, a planned and supervised process of dose reduction or total cessation of medication, is a solution to combat this.

Objective

This study aimed to identify barriers and enablers of deprescribing as experienced by nursing home physicians (NHPs) and collaborating pharmacists in the specific nursing home setting.

Methods

This qualitative study utilized a semi-structured interview format with two focus groups consisting of a mix of NHPs and pharmacists. Directed content analysis was performed based on the Theoretical Domains Framework, a validated framework for understanding determinants of behavior change among health care professionals.

Results

Sixteen health care professionals participated in two focus groups, including 13 NHPs and three pharmacists. The participating NHPs and pharmacists believed that deprescribing is a valuable process with enablers, such as multidisciplinary collaboration, good communication with patients and family, and involvement of the nursing staff. NHPs and pharmacists view deprescribing as a core task and feel assured in their ability to carry it out successfully. However, they also noted barriers: deprescribing is time-consuming; communication with residents, their relatives or medical specialists is difficult; and electronic patient systems often do not adequately support it.

Conclusions

This study provides insight into the various barriers and enablers faced by NHPs and pharmacists when deprescribing in nursing homes. Specific for this population, deprescribing barriers focus on communication (with residents and their relatives, and also with medical specialists) and resources, while knowledge and expertise are mentioned as enablers.

SUBMITTER: Visser AGR

PROVIDER: S-EPMC10925566 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Publications

Unlocking Deprescribing Potential in Nursing Homes: Insights from a Focus Group Study with Healthcare Professionals.

Visser Anne G R AGR de-Bruijn Jenny B G Poddighe JBGP Spaetgens Bart B Winkens Bjorn B Janknegt Rob R Schols Jos M G A JMGA

Drugs & aging 20240129 3

<h4>Background</h4>The nursing home population is characterized by multimorbidity and disabilities, which often result in extensive prescription of medication and subsequent polypharmacy. Deprescribing, a planned and supervised process of dose reduction or total cessation of medication, is a solution to combat this.<h4>Objective</h4>This study aimed to identify barriers and enablers of deprescribing as experienced by nursing home physicians (NHPs) and collaborating pharmacists in the specific nu ...[more]

PMID: 38285238

Similar Datasets

Project description:ObjectiveTo examine the determinants of deprescribing among health professionals in nursing homes, focusing on knowledge, practice and attitude.DesignThis was a qualitative study comprising semi-structured face-to-face interviews guided by 10 open-ended questions. Interviews were conducted until data saturation was achieved and no new ideas were formed. The interviews were audio-recorded, transcribed verbatim and analysed for themes. To derive themes, we employed directed content analysis of transcript data. Coding was completed using a combination of open, axial and selective coding.SettingFour nursing homes in Singapore.ParticipantsThe study involved 17 participants (comprising 4 doctors, 4 pharmacists and 9 nurses).ResultsTwo key themes were identified, enablers and challenges. These were enablers and challenges faced by doctors, pharmacists and nurses towards deprescribing. The identified subthemes for enablers of deprescribing were: (1) awareness of medications that are unnecessary or could be targeted for deprescribing; (2) improving quality of life for patients with limited life expectancy; (3) improving communication between doctors, pharmacists and nurses; (4) systematic deprescribing practice and educational tools and (5) acknowledgement of possible benefits of deprescribing. The identified subthemes for challenges of deprescribing were: (1) symptoms not acknowledged as possibly drug-related; (2) lack of knowledge in patient's and family members' preferences; (3) lack of coordination between health professionals in hospitals and nursing homes and (4) limited tools for deprescribing. The development of a local guideline, mentoring nurses, case discussions, better shared decision-making and improving multidisciplinary communication, may help to support the process of deprescribing.ConclusionIn conclusion, this study highlighted that deprescribing in the nursing homes is perceived by health professionals to be challenging and future research could assess how routine case studies, mentoring and better multidisciplinary communication could improve deprescribing knowledge and process in the nursing homes.

Project description:BackgroundAn ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients' complex needs. This study describes graduate students' experiences of working practice based in interprofessional teams with complex patients' care needs in nursing homes.MethodStudents from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data.ResultsThree themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified.ConclusionsIPE in nursing homes facilitated the students' scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students' curricula. This could ensure that IPE is experienced more efficient by the students.

Project description:BackgroundDeprescribing polypharmacy and potentially inappropriate medications (PIMs) has been shown to be beneficial to nursing home (NH) residents' health. Medication reviews are the most widely studied deprescribing intervention; in a previous trial, we showed that another intervention, a deprescribing-focused interprofessional quality circle, can reduce the use of inappropriate medications at the NH level. However, this intervention cannot account for the variety of the residents' clinical situations. Therefore, we trialled a subsequent intervention in NH that enacted the quality circle intervention in the previous year.MethodsIn 7 NHs, the most heavily medicated residents were recruited and randomised to receive usual care or the intervention. The intervention was a pharmacist-led, deprescribing-focused medication review, followed by the creation of an individualised treatment modification plan in collaboration with nurses and physicians. Intervention's effects were assessed after four months on the number and dose of PIMs used, quality of life, and safety outcomes (mortality, hospitalisations, falls, and use of physical restraints). Data were analysed using Poisson multivariate regression models.ResultsSixty-two NH residents participated, falling short of the expected 100 participants; 4 died before initial data collection. Participants used a very high number of drugs (median 15, inter-quartile range [12-19]) and PIMs (median 5, IQR [3-7]) at baseline. The intervention did not reduce the number of PIMs prescribed to the participants; however, it significantly decreased their dose (incidence rate ratio 0.763, CI95 [0.594; 0.979]), in particular for chronic drugs (IRR 0.716, CI95 [0.546; 0.938]). No adverse effects were seen on mortality, hospitalisations, falls, and restraints use, but, in the intervention group, three participants experienced adverse events that required the reintroduction of withdrawn treatments, and a decrease in quality of life is possible.ConclusionsAs it did not reach its recruitment target, this trial should be seen as exploratory. Results indicate that, following a NH-level deprescribing intervention, a resident-level intervention can further reduce some aspects of PIMs use. Great attention must be paid to residents' well-being when further developing such deprescribing interventions, as a possible reduction in quality of life was found in the intervention group, and some participants suffered adverse events following deprescribing.Trial registrationClinicalTrials.gov (NCT03688542, https://clinicaltrials.gov/ct2/show/NCT03688542 ), registered on 31.08.2018.

Project description:Presenteeism can have negative impacts on employees' health and organizational productivity. It occurs more often among occupations with high attendance demands, such as healthcare professionals. Information is lacking regarding the extent to which presenteeism differs between disciplines and settings in the health sector and what the reasons are for presenteeism as well as influencing factors. This study used cross-sectional data on 15,185 healthcare professionals (nursing staff, midwives, physicians, medical-technical and medical-therapeutic professionals) from various settings (acute care, rehabilitation or psychiatric hospitals, nursing homes and home care organizations). Presenteeism was measured by examining how many days participants had gone to work despite feeling sick during the past 12 months. Kruskal-Wallis was used to test for significant differences between healthcare professions/settings and regression analysis to identify significant predictors of presenteeism. Nursing assistants with a formal education reported the most days of presenteeism in the past 12 months (mean = 4.3, SD = 12.0). Healthcare professionals working in nursing homes reported the most days of presenteeism in the past 12 months (mean = 4.2, SD = 8.7). The majority of healthcare professionals had been present at work while being ill due to a sense of duty (83.7%), followed by consideration for colleagues and/or managers (76.5%). In particular, the psychiatric hospitals (β = 0.139; p < 0.001), nursing homes (β = 0.168; p < 0.001) and home care organizations (β = 0.092; p < 0.001), as well as the language regions of Swiss French (β = - 0.304; p < 0.001) and Italian (β = - 0.154; p < 0.001), were significantly associated with presenteeism. Presenteeism differs between disciplines and settings in the health sector. The reasons for presenteeism and its influencing factors in the health sector are mostly consistent with those in other sectors. Cultural differences should be afforded greater relevance in future presenteeism research.

Project description:BackgroundPolypharmacy and potentially inappropriate medications (PIMs) are still frequent among older adults in nursing homes. Deprescribing is an intervention that has been shown to be effective in reducing their use. However, the implementation of deprescribing in clinical practice has not yet been widely evaluated. The Quality Circle Deprescribing Module (QC-DeMo) intervention has been trialled through an effectiveness-implementation hybrid type 2 design. The intervention consists of a quality circle workshop session between healthcare professionals HCPs (physicians, nurses, and pharmacists) within a nursing home, in which they define a consensus to deprescribe specific PIMs classes. The aim of this study was to evaluate the implementation of the QC-DeMo intervention in nursing homes.MethodsThis observational study focuses on the implementation part of the QC-DeMo trial. Implementation was based on the Framework for Implementation of Pharmacy Services (FISpH). Questionnaires at baseline and follow-up were used to evaluate reach, adoption, implementation effectiveness, fidelity, implementation, maintenance and the implementation strategies. Other data were collected from the QC-DeMo trial and routine data collected as part of the integrated pharmacy service where the QC-Demo trial was embedded. Implementation strategies included training of pharmacists, integration of the intervention into an existing quality circle dynamic and definition of tailored strategies to operationalise the consensus by each nursing home.ResultsThe QC-DeMo intervention was successfully implemented in 26 nursing homes in terms of reach, fidelity, adoption, implementation and implementation effectiveness. However, the intervention was found to be implemented with low maintenance as none of the nursing homes repeated the intervention after the trial. Implementation strategies were well received by HCPs: training was adequate according to pharmacists. Pre-existing quality circle dynamic facilitated interprofessional collaboration as involvement and support of each HCP was rated as high. HCPs recognized a specific and important role for each HCP in the deprescribing process. The most relevant tailored strategies to implement the consensus defined by each nursing home were identification of the patients by the pharmacist and a systematic review of medication's patients.ConclusionsThe implementation of a Quality Circle on Deprescribing is feasible but its maintenance in practice remains challenging. This study explores multiple implementation outcomes to better inform future implementation efforts of these types of interventions.Trial registrationClinicalTrials.gov ( NCT03688542 ), registered on 26.09.2018.

Project description:BackgroundDelivering high quality care tailored to patients' needs necessitate patient-centered communication. High physical and mental workload, as well as organizational barriers, contribute to challenges nurses face in patient-centered communication. Participation in a communication skills training can help nurses to improve their patient-centered communication skills. Thus, the aim of this study was to investigate the experiences of nursing professionals in patient-centered communication and delineate the requisite content for a communication skills training.MethodsWe conducted focus group interviews with nursing professionals working at an academic medical center in Germany. The focus group interviews were audio-recorded and transcribed verbatim. Data analysis was performed using Kuckartz's qualitative content analysis.Results31 nursing professionals from diverse medical disciplines (e.g., pediatrics, obstetrics, cardiology, neurology, oncology) participated in the study, unveiling a spectrum of communication experiences, including organizational and system-related challenges, constraints induced by the COVID-19 pandemic, management of personal emotions, and communication challenges with patients and relatives. They also identified aspects they experienced as beneficial for patient-centered communication (e.g., allocating sufficient time, being authentic, providing clear information). Furthermore, participants identified specific aspects, which should be included in a patient-centered communication skills training.ConclusionThe findings suggests that not only nurses from oncology and intensive care, but also from other medical disciplines, experience significant communication challenges with patients and relatives. Applying patient-centered aspects of communication was considered beneficial for effective communication. The needs identified through participants' experiences (e.g., core communication skills and strategies, handling escalating situations, and discussing serious illness, death and dying) informed the development of a patient-centered communication skills training specifically tailored for nursing professionals across diverse medical disinclines in Germany.

Dataset Information

Unlocking Deprescribing Potential in Nursing Homes: Insights from a Focus Group Study with Healthcare Professionals.

Background

Objective

Methods

Results

Conclusions

Publications

Unlocking Deprescribing Potential in Nursing Homes: Insights from a Focus Group Study with Healthcare Professionals.

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