Feasibility of implementing an intervention in general practice for deprescribing of glucose-lowering medication in overtreated elderly.

IF 2.2 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Family practice Pub Date : 2025-08-14 DOI:10.1093/fampra/cmaf064

Charlotte Andriessen, Marieke T Blom, Beryl A C E van Hoek, Anna W de Boer, Petra Denig, Ron Herings, Angela de Rooij-Peek, Rob J van Marum, Jacqueline G Hugtenburg, Daniël van Raalte, Liselotte van Bloemendaal, Giel Nijpels, Marjan J Westerman, Rimke C Vos, Petra J M Elders

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引用次数: 0

Abstract

Background: Elderly patients with Type 2 diabetes (T2D) are frequently overtreated with glucose-lowering medication.

Objective: This feasibility study evaluated the implementation of a deprescribing programme (DPP) for general practices, consisting of education, a patient selection tool, practice visits, and an expert support panel, before scaling it in a randomized controlled trial.

Methods: Quantitative evaluation included the number of patients with T2D eligible for deprescribing using medical records and study progress data. Qualitative evaluation entailed the analysis of minutes made during training, and interviews with health care providers (HCPs). The extended normalization process theory guided analysis.

Results: In 10 practices, 55 out of 65 eligible patients were deprescribed glucose-lowering medication, with 22 restarts. Most execution steps were perceived as the practice nurse's responsibility, whereas the general practitioner needed to approve the deprescribing. Practice nurses found the educational training, including peer-to-peer sessions and practice visits, supportive of integrating deprescribing into practice. DPP procedures and tasks not part of the regular care process were not consistently performed. The DPP was adapted to minimize study tasks for HCPs and align study procedures to existing routine procedures.

Conclusion: Implementation of a DPP in general practice requires education, practice visits, and alignment of DPP components to regular care.

Abstract Image

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在全科实践中对过度治疗的老年人降糖药处方实施干预的可行性。

背景：老年2型糖尿病（T2D）患者经常过度使用降糖药物。目的：本可行性研究在随机对照试验前评估了全科实践中处方化规划（DPP）的实施，包括教育、患者选择工具、实践访问和专家支持小组。方法：采用病历资料和研究进展资料对符合处方要求的T2D患者数量进行定量评价。定性评价包括对培训期间的会议记录进行分析，以及对卫生保健提供者（HCPs）进行访谈。扩展归一化过程理论指导了分析。结果：在10个实践中，65例符合条件的患者中有55例被开了降糖药，22例重新开始。大多数执行步骤被认为是执业护士的责任，而全科医生需要批准处方。实习护士发现教育培训，包括点对点会议和实习访问，有助于将处方纳入实践。不属于常规护理程序的DPP程序和任务没有得到一致的执行。对DPP进行了调整，以尽量减少医护人员的研究任务，并使研究程序与现有的常规程序保持一致。结论：在全科实践中实施DPP需要教育，实践访问，并将DPP组成部分与常规护理相结合。

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

Family practice 医学-医学：内科

CiteScore

4.30

自引率

9.10%

发文量

144

审稿时长

4-8 weeks

期刊介绍： Family Practice is an international journal aimed at practitioners, teachers, and researchers in the fields of family medicine, general practice, and primary care in both developed and developing countries. Family Practice offers its readership an international view of the problems and preoccupations in the field, while providing a medium of instruction and exploration. The journal''s range and content covers such areas as health care delivery, epidemiology, public health, and clinical case studies. The journal aims to be interdisciplinary and contributions from other disciplines of medicine and social science are always welcomed.