Delivering the right information to the right person at the right time to facilitate deprescribing in hospital

a mixed methods multisite study to inform decision support design in Australia

Melissa T. Baysari*, Mai Duong, Wu Yi Zheng, Amy Nguyen, Sarita Lo, Brendan Ng, Angus Ritchie, David Le Couteur, Andrew McLachlan, Alexandra Bennett, Sarah Hilmer

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objectives To inform the design of electronic decision support (EDS) to facilitate deprescribing in hospitals we set out to (1) explore the current processes of in-hospital medicines review, deprescribing and communication of deprescribing decisions with the patient's general practitioner (GP), (2) identify barriers to undertaking these tasks and (3) determine user preferences for EDS. Design Multimethod, multisite study comprising observations, semistructured interviews and focus groups. Setting General medicine, geriatric medicine and rehabilitation wards at six hospitals in two local health districts in Sydney, Australia and primary care practices in one primary healthcare district in Sydney, Australia. Participants 149 participants took part in observations, interviews and focus groups, including 69 hospital doctors, 13 nurses, 55 pharmacists and 12 GPs. Main outcome measures Observational data on who was involved in medicines review and deprescribing, when medicines review took place, and what artefacts (eg, forms) were used. Participants reported perceptions of medicines review, polypharmacy and deprescribing and preferences for EDS. Results Deprescribing, undertaken during medicines review, was typically performed by a junior doctor, following a decision to deprescribe by a senior doctor. Key barriers to deprescribing included a perception that deprescribing was not the responsibility of hospital doctors, a lack of confidence among junior doctors and pharmacists in broaching this topic with senior doctors and a lack of patient engagement in the deprescribing process. In designing EDS, the tools, likely to be used by junior doctors, pharmacists and nurses, should be available throughout the hospitalisation and should comprise non-interruptive evidence-based guidance on why and how to deprescribe. Conclusions Deprescribing decisions are complex and influenced by multiple factors. The implementation of EDS alone is unlikely to address all barriers identified. To achieve sustained improvements in monitoring of polypharmacy and subsequent deprescribing, a multifaceted intervention is needed.

Original languageEnglish
Article numbere030950
Pages (from-to)1-9
Number of pages9
JournalBMJ Open
Volume9
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • decision support
  • deprescribing
  • polypharmacy

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