How can we improve deprescribing communication among patients with dementia and multiple chronic conditions?
A qualitative study in primary care lends key insights.

Green AR, et al. Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: A Qualitative Study. J Gen Intern Med. 2020 Dec;35(12):3556-63. DOI: 10.1007/s11606-020-06063-y.

Researchers from Johns Hopkins University and Kaiser Permanente Colorado conducted a qualitative study to determine patient, caregiver, and physician preferences for discussing deprescribing in primary care visits for patients experiencing dementia and multiple chronic conditions. Part of the Optimal Medication Management in Alzheimer’s Disease and Dementia (OptiMize) study, a trial designed to increase awareness of deprescribing in primary care settings, this study also focused on culturally competent messages as they relate to deprescribing. Semi-structured interviews with 17 patients, 16 caregivers, and 16 physicians revealed several key themes:

  1. trust between patients, caregivers, and physicians is critical for uptake of deprescribing,
  2. deprescribing should be framed positively as routine care,
  3. aligning dementia care goals and symptom management with deprescribing is essential,
  4. direct-to-patient informational materials are helpful, as are suggested language for physicians to use during clinical encounters,
  5. deprescribing could benefit from engaging the entire health care team, such as pharmacists to aid in follow up.

Interviews also revealed that racial or ethnic discordance between patients and physicians, language barriers, and time pressures can contribute to less effective and trusting interactions and thus hinder deprescribing efforts. These findings lend important insight as the OptiMize trial moves forward in its goal to increase awareness of deprescribing in patients with dementia and multiple chronic conditions in primary care.

Primary author Dr. Ariel Green said:

“Implementing successful deprescribing interventions will take tailored communication strategies that address the specific concerns of people living with various stages of dementia, their caregivers, and patients from minority racial or ethnic backgrounds. Our qualitative study identifies key language to support deprescribing in primary care, particularly for older adults with dementia and multiple chronic conditions.”

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