Prescriber perspectives on low-value prescribing: A qualitative study.
deprescribing
low-value care
medication value
polypharmacy
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
12
02
2021
received:
15
11
2020
accepted:
16
02
2021
pubmed:
13
3
2021
medline:
7
10
2021
entrez:
12
3
2021
Statut:
ppublish
Résumé
Health systems are increasingly implementing interventions to reduce older patients' use of low-value medications. However, prescribers' perspectives on medication value and the acceptability of interventions to reduce low-value prescribing are poorly understood. To identify the characteristics that affect the value of a medication and those factors influencing low-value prescribing from the perspective of primary care physicians. Qualitative study using semi-structured interviews. Academic and community primary care practices within University of Pittsburgh Medical Center health system. Sixteen primary care physicians. We elicited 16 prescribers' perspectives on definitions and examples of low-value prescribing in older adults, the factors that incentivize them to engage in such prescribing, and the characteristics of interventions that would make them less likely to engage in low-value prescribing. We identified three key themes. First, prescribers viewed low-value prescribing among older adults as common, characterized both by features of the medications themselves and of the particular patients to whom they were prescribed. Second, prescribers described the causes of low-value prescribing as multifactorial, with factors related to patients, prescribers, and the health system as a whole, making low-value prescribing a default practice pattern. Third, interventions addressing low-value prescribing must minimize the cognitive load and time pressures that make low-value prescribing common. Interventions increasing time pressure or cognitive load, such as increased documentation, were considered less acceptable. Our findings demonstrate that low-value prescribing is a well-recognized phenomenon, and that interventions to reduce low-value prescribing must consider physicians' perspectives and address the specific patient, prescriber and health system factors that make low-value prescribing a default practice.
Sections du résumé
BACKGROUND
Health systems are increasingly implementing interventions to reduce older patients' use of low-value medications. However, prescribers' perspectives on medication value and the acceptability of interventions to reduce low-value prescribing are poorly understood.
OBJECTIVE
To identify the characteristics that affect the value of a medication and those factors influencing low-value prescribing from the perspective of primary care physicians.
DESIGN
Qualitative study using semi-structured interviews.
SETTING
Academic and community primary care practices within University of Pittsburgh Medical Center health system.
PARTICIPANTS
Sixteen primary care physicians.
MEASUREMENTS
We elicited 16 prescribers' perspectives on definitions and examples of low-value prescribing in older adults, the factors that incentivize them to engage in such prescribing, and the characteristics of interventions that would make them less likely to engage in low-value prescribing.
RESULTS
We identified three key themes. First, prescribers viewed low-value prescribing among older adults as common, characterized both by features of the medications themselves and of the particular patients to whom they were prescribed. Second, prescribers described the causes of low-value prescribing as multifactorial, with factors related to patients, prescribers, and the health system as a whole, making low-value prescribing a default practice pattern. Third, interventions addressing low-value prescribing must minimize the cognitive load and time pressures that make low-value prescribing common. Interventions increasing time pressure or cognitive load, such as increased documentation, were considered less acceptable.
CONCLUSIONS
Our findings demonstrate that low-value prescribing is a well-recognized phenomenon, and that interventions to reduce low-value prescribing must consider physicians' perspectives and address the specific patient, prescriber and health system factors that make low-value prescribing a default practice.
Identifiants
pubmed: 33710629
doi: 10.1111/jgs.17099
pmc: PMC8192466
mid: NIHMS1689355
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1500-1507Subventions
Organisme : NIA NIH HHS
ID : K23 AG061217
Pays : United States
Organisme : NIA NIH HHS
ID : K23AG061217
Pays : United States
Informations de copyright
© 2021 The American Geriatrics Society.
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