Abstract
Background/aims: At the end of life some medication may no longer be beneficial to patients, yet may cause harm. These include side effects, pill burden, medication interactions and economic costs. Discontinuation of Potentially Inappropriate Medication (PIM) in response to changed life circumstances is referred to as deprescription.
Despite widespread intent to minimise PIM use, real-life practice of deprescribing medication is poorly enacted in primary care. Literature details that 45% of patients in the last months of life received prescrip- tions that were potentially inappropriate, and 25% used this medication on the day of death. This study explores the factors influencing depre- scribing in primary care for patients with life limiting conditions and their health professionals.
Methods: Qualitative study with semi-structured interviews conducted between June and October 2022, with purposely selected patients and health practitioners (HCPs; GPs, pharmacists, nurses) in Utrecht, The Netherlands. Inductive thematic analysis was employed for data analysis.
Results: 17 Interviews were performed, with three main themes emerg- ing from the data:
Uncertainty; influenced by the poor reliability of predictions of life expectancy and lack of clear guidance regarding deprescription.
Lack of awareness; relative underexposure of risk of PIMs and overlook- ing of patients that could benefit from deprescription, especially within the chronically ill and elderly population.
Discontinuity of care; deprescribing is an ongoing and sensitive process facilitated by a trusted treatment relationship, personalised care and multidisciplinary collaboration.
Conclusions: This study identifies options to further facilitate depre- scription in the last phase of life in primary care, like embedding depre- scription in multidisciplinary routine care, supported by training on medication risks and guidelines customised for primary care that pro- mote shared decision making. This study was funded by ZonMW.
Despite widespread intent to minimise PIM use, real-life practice of deprescribing medication is poorly enacted in primary care. Literature details that 45% of patients in the last months of life received prescrip- tions that were potentially inappropriate, and 25% used this medication on the day of death. This study explores the factors influencing depre- scribing in primary care for patients with life limiting conditions and their health professionals.
Methods: Qualitative study with semi-structured interviews conducted between June and October 2022, with purposely selected patients and health practitioners (HCPs; GPs, pharmacists, nurses) in Utrecht, The Netherlands. Inductive thematic analysis was employed for data analysis.
Results: 17 Interviews were performed, with three main themes emerg- ing from the data:
Uncertainty; influenced by the poor reliability of predictions of life expectancy and lack of clear guidance regarding deprescription.
Lack of awareness; relative underexposure of risk of PIMs and overlook- ing of patients that could benefit from deprescription, especially within the chronically ill and elderly population.
Discontinuity of care; deprescribing is an ongoing and sensitive process facilitated by a trusted treatment relationship, personalised care and multidisciplinary collaboration.
Conclusions: This study identifies options to further facilitate depre- scription in the last phase of life in primary care, like embedding depre- scription in multidisciplinary routine care, supported by training on medication risks and guidelines customised for primary care that pro- mote shared decision making. This study was funded by ZonMW.
| Original language | English |
|---|---|
| Journal | Palliative Medicine |
| Volume | 37 |
| Issue number | 1 suppl. |
| DOIs | |
| Publication status | Published - 30 Jun 2023 |
| Event | European Association of Palliative Care World Research Congress - Netherlands, Rotterdam Duration: 15 Jun 2023 → 17 Jun 2023 |