| A Collaborative Intervention for Streamlining Medication Appropriateness and Deprescribing within Integrated Health-Care Teams: The Role of Stakeholder and Patient EngagementWe aim to introduce a deprescribing framework and toolbox of resources into collaborative primary healthcare clinics and long-term care facilities that have pharmacists integrated in these settings. Specifically, we anticipate that pharmacists can effectively offer patient support and clinical monitoring during the deprescribing process. At a recent World Café Workshop on future deprescribing priorities, Canadian researchers identified that, in addition to implementation evaluation and economic analyses, high quality clinical trials require meaningful patient engagement. While our multidisciplinary research team included researchers, policy makers and clinicians, we recognized the need for a strong patient voice. As such, sixteen members of our research team met with six patient representatives (identified by the Maritime SPOR SUPPORT Unit) in a “live day” stakeholder engagement meeting. The event provided a welcoming environment for all participants; discussion groups ensured a mix of clinical, research and patient voice, and facilitators focused on engaging all voices equally. Day One discussions were structured around four topics: 1) identifying and prioritizing potentially inappropriate medications to reduce or stop; 2) identifying patients appropriate for deprescribing; 3) effectively communicating deprescribing with both patients and prescribers; and 4) measuring satisfaction with the framework. Day Two used the previous day’s input to have groups draft possible frameworks. After the event, participants continued to engage via e-mail, as they refined the proposed framework. The “live day” provided helpful insight into patients’ interests and changed the shape of the project. For example, patient representatives felt that age restrictions on potential participants was unfair, as deprescribing may help people younger than 65 years of age. Patient representatives also felt it was crucial to have resources to offer with non-pharmacologic information to increase success of deprescribing. Overall, this process allowed us to have successful and meaningful patient engagement that aligned well with priorities for deprescribing clinical trials. Horizon Health Network, Maritime SPOR SUPPORT Unit, Dalhousie University | Publication | 2019-01-24 | Shanna Trenaman, Bryn Robinson, Marjorie Willison, Melissa Andrew |
| An intervention to support pharmacist led deprescribing in primary careIntroduction: Stopping medications (“deprescribing”), is just as important as starting medications. Maintaining the most appropriate medication use is challenging and time consuming for primary care providers, as patients require education and support for successful deprescribing.
Objective: The goal of this project is to develop, implement and evaluate a practical, feasible, and acceptable intervention for pharmacists in integrated primary healthcare teams to support deprescribing.
Methods: A research team was assembled that included 20 researchers, clinicians, and policymakers and six patient and caregiver representatives. This team met for a two-day facilitated meeting with follow-up communication via email to develop a deprescribing intervention for implementation in primary care sites, including nursing homes, that have a team pharmacist.
Results: The deprescribing intervention is based on a framework of communication and education. Deprescribing is to be pharmcist-led and to follow well recognized expert sources. A curated toolbox of resources for both patients and healthcare professionals supports the deprescribing of eight classes of medications (benzodiazepines, sedatives, antipsychotics, strong anticholinergics, proton pump inhibitors, colchicine, antihypertensives in patients with a history of falling, and opioids). The toolbox can be accessed online at FewerMedsLessRisk.ca. Pharmacist support will be tailored to meet the needs of the patient to help achieve deprescribing goals.
Conclusions: A diverse team has created a pharmacist led deprescribing intervention to support deprescribing to improve medication appropriateness for older adults in primary care. The intervention is being trialed at 3 primary healthcare sites across Nova Scotia and New Brunswick and 3 nursing homes in New Brunswick. Horizon Health Network, Maritime SPOR SUPPORT Unit, Horizon Health Network, New Brunswick, Dalhousie University, Dalhousie University, College of Pharmacy and Faculty of Medicine, Dalhousie University | Publication | 2019-10-25 | Shanna Trenaman, Bryn Robinson, Pamela Jarrett, Jennifer Isenor, Marjorie Willison, Melissa Andrew |
| A collaborative intervention for deprescribing: The role of stakeholder and patient engagement.Abstract
BACKGROUND:
At a recent World Café Workshop on future deprescribing priorities, Canadian researchers identified that, in addition to implementation evaluation and economic analyses, high quality clinical trials require meaningful patient engagement.
OBJECTIVES:
The aim was to develop a deprescribing intervention for collaborative primary healthcare clinics and long-term care facilities that have pharmacists integrated in these settings. This manuscript aims to provide a summary of the experience with engaging patients in the development of the deprescribing framework.
METHODS:
Sixteen members of the research team met with six patient representatives (identified by the Maritime SPOR SUPPORT Unit) in a facilitated meeting. The event provided a welcoming environment for all participants; discussion groups ensured a mix of clinical, research and patient voice; and facilitators focused on engaging all voices equally. Initial discussions were structured around four topics: 1) identifying and prioritizing potentially inappropriate medications to reduce or stop; 2) identifying patients appropriate for deprescribing; 3) effectively communicating deprescribing with both patients and prescribers; and 4) measuring satisfaction with the framework. Subsequent discussions used group input to draft an intervention. After the event, participants engaged via e-mail, to refine the proposed intervention.
RESULTS:
The facilitated meeting provided helpful insight into patients' interests and changed the shape of the project. For example, patient representatives felt that an age restriction of 65 years of age or older was unfair, as deprescribing may help people younger than 65 years of age. Patient representatives also felt it was crucial to have resources to offer with non-pharmacologic information to increase success of deprescribing. This led to the deprescribing intervention becoming a framework for pharmacist-led deprescribing and a toolbox of supportive patient and healthcare professional resources.
CONCLUSIONS:
Overall, this process allowed for successful and meaningful patient engagement that aligned well with priorities for deprescribing clinical trials. Horizon Health Network, Maritime SPOR SUPPORT Unit, Dalhousie University | Publication | 2019-10-01 | Shanna Trenaman, Bryn Robinson, Marjorie Willison, Melissa Andrew |
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