Stakeholder Perspectives on the Use of Telehealth to Support Deprescribing for Older Patients Transitioning From the Hospital to Home Health Care

Abstract

Background

Multimorbidity affects most older adults in home health care (HHC), leading to inappropriate polypharmacy and increased risks for adverse outcomes. While deprescribing can mitigate these risks, fragmented communication during hospital-to-home transitions remains a major barrier. This study explored stakeholder perspectives on using telehealth to facilitate deprescribing for older adults with multimorbidity while receiving post-acute HHC.

Methods

We conducted semi-structured interviews with 44 stakeholders across 12 U.S. states, including 14 HHC patients and 30 clinicians (physicians, nurse practitioners, pharmacists, and HHC nurses). Guided by the socioecological model of deprescribing, interviews explored factors across individual, interpersonal, organizational, and societal levels associated with telehealth use in deprescribing. Analysis followed a phased, iterative approach with independent double-coding and interprofessional team consensus to ensure credibility.

Results

Findings categorized telehealth as a promising tool to align medications with the “4Ms” (Medications, Mentation, Mobility, and What Matters) through goal-concordant deprescribing. At the individual level, stakeholders noted that telehealth readiness depended on patient cognition and digital literacy. At the interpersonal level, telehealth facilitated real-time multidisciplinary “virtual huddles” that reduced communication delays but could occasionally overwhelm patients and may be logistically challenging to schedule. Organizational barriers included reimbursement constraints and complex synchronous scheduling. Societal factors include equitable access for rural or low-income populations, populations who may benefit the most from telehealth-enabled deprescribing due to challenges in accessing care. Stakeholders emphasized a hybrid approach which pairs virtual prescriber consultation with in-home support of a clinician to provide context and assist with implementation for patient-centered deprescribing.

Conclusions

Telehealth can support goal-concordant deprescribing during post-acute care transitions in HHC. A hybrid model, one that combines remote prescriber consultations with in-home clinician support, is the preferred approach to bridge coordination gaps. To maximize impact, future efforts are needed to improve reimbursement, infrastructure, and scheduling to integrate telehealth into routine deprescribing workflows.