Enhancing older Veterans' care: Insights from medication reviews and deprescribing interventions.

IF 3.7 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Helen Omuya, Lauren Welch, Trisha Seys Raňola, Macy E McConnell, Jéssica Soares Malta, Amy Genisot, Hannah Schuh, Betty Chewning
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引用次数: 0

Abstract

Background: Patient experience during and after health care is a critical indicator of quality of care that encompasses effective communication, respect, dignity, and emotional support. However, qualitative studies exploring the experiences of older adults after deprescribing interventions are sparse, highlighting a knowledge gap. This project seeks to address this gap by exploring Veterans' experiences during and after a deprescribing intervention provided by a pharmacist. This study aims to: 1. Assess Veteran's experience of the process of their Comprehensive Medication Review and deprescribing intervention visit; 2. Assess the Veteran's experience with the outcomes of their Comprehensive Medication Review and deprescribing intervention.

Method: Data was collected from 17 Veterans through semi-structured interviews using an interview guide. The Veteran Affairs study site utilizes the VIONE polypharmacy risk calculator to identify high-risk Veterans; the majority of these Veterans were on at least 10 medications. The interview transcripts were analyzed using inductive content analysis. Two research team members independently coded the data for categories and themes. Similarities were identified, and any divergence was discussed and resolved. To enhance the validity of the findings, member checking was performed with Veterans to confirm the results.

Result and discussion: Most Veterans viewed the process of the pharmacists' visits and recommendations positively. They expressed confidence in pharmacists' knowledge and instructions. They appreciated the clarity of information pharmacists provided about the purpose, proper administration, and interactions of their medications. These enhanced the Veterans' ability to manage their medication regime. They also desired an increased frequency of interactions with their pharmacist due to these positive interactions. Veterans appreciated interprofessional collaboration between pharmacists, physicians, and other providers. Veterans expressed how pivotal lab test results were for evaluating medication recommendations and effectiveness. Most Veterans reported positive outcomes and/or indicated there were no negative effects as a result of their recent medication changes. Some reported seeking additional information from their providers regarding suggested medication changes to validate recommendations. There was some uncertainty about whether there would be follow-up visits with the professional after the medication change and who should initiate this. A minority indicated problems associated with prior medication discontinuation before the deprescribing intervention and how this limited their openness to future opportunities of deprescribing.

Conclusion: This exploration of Veterans' experiences with the process and outcomes of a deprescribing service affirms its importance and overall success in this site as part of the unique publicly funded Veteran healthcare system in the US. Equally important, the positive Veteran response suggests the value of exploring its potential to benefit patients experiencing polypharmacy across a range of other sites and systems.

加强老年退伍军人的护理:从药物审查和取消处方干预中获得启示。
背景:患者在接受医疗服务期间和之后的体验是衡量医疗服务质量的重要指标,其中包括有效沟通、尊重、尊严和情感支持。然而,探讨老年人在接受处方干预后的体验的定性研究却很少,这凸显了知识上的差距。本项目旨在通过探索退伍军人在药剂师提供的开处方干预期间和之后的经历来弥补这一空白。本研究旨在1.评估退伍军人在全面用药检查和处方干预访问过程中的体验;2. 评估退伍军人在全面用药检查和处方干预结果方面的体验:方法:使用访谈指南,通过半结构化访谈从 17 名退伍军人处收集数据。退伍军人事务研究机构利用 VIONE 多药风险计算器来识别高风险退伍军人;这些退伍军人中的大多数至少服用 10 种药物。访谈记录采用归纳内容分析法进行分析。两名研究小组成员独立对数据进行分类和主题编码。找出相似之处,并讨论和解决任何分歧。为了提高研究结果的有效性,还与退伍军人进行了成员核对,以确认研究结果:大多数退伍军人对药剂师的访问过程和建议持肯定态度。他们对药剂师的知识和指导表示信任。他们对药剂师提供的有关药物的目的、正确用药和相互作用的清晰信息表示赞赏。这些都提高了退伍军人管理药物的能力。由于这些积极的互动,他们还希望增加与药剂师互动的频率。退伍军人对药剂师、医生和其他医疗服务提供者之间的跨专业合作表示赞赏。退伍军人表示,实验室检测结果对于评估用药建议和有效性至关重要。大多数退伍军人都报告了积极的治疗效果,并/或表示近期换药后没有产生任何负面影响。一些退伍军人报告说,他们向医疗服务提供者寻求更多有关药物更换建议的信息,以验证建议的有效性。有些退伍军人不确定在换药后是否会与专业人员进行随访,以及由谁来启动随访。少数退伍军人指出了在取消处方干预之前停药所带来的问题,以及这如何限制了他们对未来取消处方机会的开放性:对退伍军人在去处方化服务的过程和结果方面的经验进行的探讨,肯定了该网站作为美国独特的政府资助退伍军人医疗保健系统的一部分所具有的重要性和取得的总体成功。同样重要的是,退伍军人的积极响应表明,在其他一系列医疗机构和系统中探索该服务的潜力,使经历多种药物治疗的患者受益,是很有价值的。
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来源期刊
Research in Social & Administrative Pharmacy
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.
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