Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qualitative study.
Introduction Problematic polypharmacy is the prescribing of five or more medications potentially inappropriately. Unintentional prescribing cascades represent an under-researched aspect of problematic polypharmacy and occur when an adverse drug reaction (ADR) is misinterpreted as a new symptom resul...
| Publicado en: | Age & Ageing Vol. 53; no. 6; pp. 1 - 13 |
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| Autores principales: | , , , , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Jun2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=178158892&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 178158892 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jun2024 vid: 53 iid: 6 pid: 622 pub: Oxford University Press / USA artinfo: ui: 178158892 10.1093/ageing/afae116 ppf: 1 ppct: 12 formats: tig: atl: Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qualitative study. aug: au: Jennings, Aisling A Doherty, Ann Sinéad Clyne, Barbara Boland, Fiona Moriarty, Frank Fahey, Tom Hally, Larry Kennelly, Seán P Wallace, Emma affil: Department of General Practice, University College Cork , Cork , Ireland Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences , Dublin , Ireland HRB Centre for Primary Care Research , Department of General Practice, RCSI University of Medicine and Health Sciences , Dublin , Ireland Data Science Centre , School of Population Health, RCSI University of Medicine and Health Sciences , Dublin , Ireland School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences , Dublin , Ireland Older People's Council , Clare , Ireland Department of Medical Gerontology , School of Medicine, Trinity College Dublin , Dublin , Ireland Department of Age-related Healthcare, Tallaght University Hospital , Dublin , Ireland su: Qualitative research Drug side effects Interviewing Confidence Patients' attitudes Research funding Polypharmacy Physicians' attitudes Medication reconciliation Descriptive statistics Thematic analysis Attitudes of medical personnel Physician practice patterns Research methodology Stakeholder analysis Drug prescribing Caregiver attitudes Pharmacists' attitudes sug: subj: Qualitative research Drug side effects Interviewing Confidence Patients' attitudes Offices of physicians Offices of Physicians (except Mental Health Specialists) Research funding Polypharmacy Physicians' attitudes Medication reconciliation Descriptive statistics Thematic analysis Attitudes of medical personnel Physician practice patterns Research methodology Stakeholder analysis Drug prescribing Caregiver attitudes Pharmacists' attitudes keyword: medication reconciliation multimorbidity older people polypharmacy prescribing cascades qualitative research medication reconciliation multimorbidity older people polypharmacy prescribing cascades qualitative research ab: Introduction Problematic polypharmacy is the prescribing of five or more medications potentially inappropriately. Unintentional prescribing cascades represent an under-researched aspect of problematic polypharmacy and occur when an adverse drug reaction (ADR) is misinterpreted as a new symptom resulting in the initiation of a new medication. The aim of this study was to elicit key stakeholders' perceptions of and attitudes towards problematic polypharmacy, with a focus on prescribing cascades. Methods qualitative one-to-one semi-structured interviews were conducted with predefined key stakeholder groups. Inductive thematic analysis was employed. Results Thirty-one stakeholders were interviewed: six patients, two carers, seven general practitioners, eight pharmacists, four hospital doctors, two professional organisation representatives and two policymakers. Three main themes were identified: (i) ADRs and prescribing cascades—a necessary evil. Healthcare professionals (HCPs) expressed concern that experiencing an ADR would negatively impact patients' confidence in their doctor. However, patients viewed ADRs pragmatically as an unpredictable risk. (ii) Balancing the risk/benefit tipping point. The complexity of prescribing decisions in the context of polypharmacy made balancing this tipping point challenging. Consequently, HCPs avoided medication changes. (iii) The minefield of medication reconciliation. Stakeholders, including patients and carers, viewed medication reconciliation as a perilous activity due to systemic communication deficits. Conclusion Stakeholders believed that at a certain depth of polypharmacy, the risk that a new symptom is being caused by an existing medication becomes incalculable. Therefore, in the absence of harm, medication changes were avoided. However, medication reconciliation post hospital discharge compelled prescribing decisions and was seen as a high-risk activity by stakeholders. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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