Stakeholders' perspectives and experiences of the pharmacist's role in deprescribing in ambulatory care: A qualitative meta-synthesis

IF 3.7 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Research in Social & Administrative Pharmacy Pub Date : 2024-04-27 DOI:10.1016/j.sapharm.2024.04.014

Amanda Kassis, Rebekah Moles, Stephen Carter

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引用次数: 0

Abstract

Background

Deprescribing is an effective strategy to manage polypharmacy and improve patient outcomes. The notion of a potential role for pharmacists in a multidisciplinary team approach to deprescribing has been identified in quantitative and qualitative literature. However, stakeholders' perceptions of this role, and factors that may impede or facilitate the pharmacist's involvement have not been elucidated. The application in ambulatory care also requires clarification. Understanding stakeholders' views is essential to optimise involvement of the pharmacist in deprescribing and improve practice.

Objectives

First, to synthesize the perspectives and experiences of stakeholders (primary care providers, pharmacists, patients, and carers) regarding the role and involvement of the pharmacist in deprescribing in ambulatory care settings. Second, to identify barriers and strategies to enhancing pharmacist involvement in deprescribing.

Methods

A systematic search was conducted across CINAHL, Embase, Medline, and Scopus from database inception to April 2023 for qualitative studies in English exploring the pharmacist's role in deprescribing. Data were extracted for iterative and inductive development of themes. A meta-synthesis facilitated the identification of overarching themes. Qualitative secondary analysis enabled identification of barriers and facilitators to the pharmacist's involvement in deprescribing.

Results

From 285 articles identified, 9 studies were included which explored the views of general practitioners, specialist physicians, pharmacists, nurse practitioners, patients, carers, and general practice and clinic staff as stakeholders in deprescribing in ambulatory care. The meta-synthesis identified 4 over-arching themes: (1) therapeutic impetus and the status quo mentality, (2) role and responsibility, (3) multidisciplinary care, and (4) conflicting interests in pharmacy practice. Strategies to enhance pharmacists' involvement in deprescribing emerged from the data, and the pharmacist's role was strongly encouraged by stakeholders despite logistical and perceptual barriers identified.

Conclusions

Incorporation of the strategies to enhance the pharmacist's involvement in deprescribing identified in this review is encouraged to optimise patient-centred care and improve practice.

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利益相关者对药剂师在门诊护理中取消处方角色的看法和经验：定性荟萃。

背景：去处方化是管理多药并改善患者预后的有效策略。定量和定性文献中都提到了药剂师在多学科团队处方中的潜在作用。然而，利益相关者对这一角色的看法以及可能阻碍或促进药剂师参与的因素尚未得到阐明。在非住院护理中的应用也需要澄清。了解利益相关者的观点对于优化药剂师在去处方化中的参与和改进实践至关重要：首先，综合利益相关者（初级医疗服务提供者、药剂师、患者和护理者）对药剂师在非住院医疗环境中的角色和参与去处方化方面的观点和经验。其次，确定加强药剂师参与去处方化的障碍和策略：方法：在 CINAHL、Embase、Medline 和 Scopus 数据库中对探讨药剂师在去处方化中的作用的英文定性研究进行了系统性检索，检索时间从数据库建立之初至 2023 年 4 月。提取的数据用于反复归纳主题。元综合有助于确定总体主题。通过二次定性分析，确定了药剂师参与去处方化的障碍和促进因素：从确定的 285 篇文章中，有 9 项研究探讨了全科医生、专科医生、药剂师、执业护士、患者、照护者以及全科诊所和诊所员工作为非住院护理中取消处方的利益相关者的观点。元综合确定了 4 个首要主题：(1) 治疗动力与现状心态，(2) 角色与责任，(3) 多学科护理，(4) 药学实践中的利益冲突。从数据中得出了加强药剂师参与去处方化的策略，尽管发现了后勤和观念上的障碍，但药剂师的作用得到了利益相关者的大力鼓励：结论：我们鼓励采用本综述中确定的策略来加强药剂师在处方开具中的参与，从而优化以患者为中心的护理并改善实践。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Research in Social & Administrative Pharmacy PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.20

自引率

10.30%

发文量

225

审稿时长

47 days

期刊介绍： Research in Social and Administrative Pharmacy (RSAP) is a quarterly publication featuring original scientific reports and comprehensive review articles in the social and administrative pharmaceutical sciences. Topics of interest include outcomes evaluation of products, programs, or services; pharmacoepidemiology; medication adherence; direct-to-consumer advertising of prescription medications; disease state management; health systems reform; drug marketing; medication distribution systems such as e-prescribing; web-based pharmaceutical/medical services; drug commerce and re-importation; and health professions workforce issues.