Challenges in Deprescribing Among Older Adults in Post-Acute Care Transitions to Home
Document Type
Article
Publication Date
1-2024
Abstract
Objectives
Medications with a higher risk of harm or that are unlikely to be beneficial are used by nearly all older patients in home health care (HHC). The objective of this study was to understand stakeholders’ perspectives on challenges in deprescribing these medications for post-acute HHC patients.Design
Qualitative individual interviews were conducted with stakeholders involved with post-acute deprescribing.Setting and Participant
Older HHC patients, HHC nurses, pharmacists, and primary/acute care/post-acute prescribers from 9 US states participated in individual qualitative interviews.Measures
Interview questions were focused on the experience, processes, roles, training, workflow, and challenges of deprescribing in hospital-to-home transitions. We used the constant comparison approach to identify and compare findings among patient, prescriber, and pharmacist and HHC nurse stakeholders.Results
We interviewed 9 older patients, 11 HHC nurses, 5 primary care physicians (PCP), 3 pharmacists, 1 hospitalist, and 1 post-acute nurse practitioner. Four challenges were described in post-acute deprescribing for HHC patients. First, PCPs' time constraints, the timing of patient encounters after hospital discharge, and the lack of prioritization of deprescribing make it difficult for PCPs to initiate post-acute deprescribing. Second, patients are often confused about their medications, despite the care team's efforts in educating the patients. Third, communication is challenging between HHC nurses, PCPs, specialists, and hospitalists. Fourth, the roles of HHC nurses and pharmacists are limited in care team collaboration and discussion about post-acute deprescribing.Conclusions and Implications
Post-acute deprescribing relies on multiple parties in the care team yet it has challenges. Interventions to align the timing of deprescribing and that of post-acute care visits, prioritize deprescribing and allow clinicians more time to complete related tasks, improve medication education for patients, and ensure effective communication in the care team with synchronized electronic health record systems are needed to advance deprescribing during the transition from hospital to home.DOI
https://doi.org/10.1016/j.jamda.2023.09.021
Publication Information
Wang, Jinjiao; Shen, Jenny Y.; Yu, Fang; Nathan, Kobi T.; Caprio, Thomas V.; Conwell, Yeates; Moskow, Marian S.; Brasch, Judith D.; Simmons, Sandra F.; Mixon, Amanda S.; and Norton, Sally A. (2024). "Challenges in Deprescribing Among Older Adults in Post-Acute Care Transitions to Home." JAMDA: The Journal of Post-Acute and Long-Term Care Medicine 25.1, P138-145.E6.
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