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Stakeholder Perspectives on Factors Related to Deprescribing Potentially Inappropriate Medications in Older adults Receiving Dialysis

Hall RK, Rutledge J, Lucas A, Liu CK, St Clair Russell J, St Peter W, Fish LJ, Colón-Emeric C. Stakeholder Perspectives on Factors Related to Deprescribing Potentially Inappropriate Medications in Older Adults Receiving Dialysis. Clin J Am Soc Nephrol. 2023 Jul 27. doi: 10.2215/CJN.0000000000000229. Epub ahead of print. PMID: 37499693.

The study by Hall et al. was an observational qualitative study conducted in Durham, North Carolina, involving semi-structured interviews and focus groups with key stakeholders. It aimed to understand the perspectives of clinicians and patients regarding deprescribing potentially inappropriate medications in older adults receiving dialysis. The study’s primary objective was to identify factors affecting the integration of deprescribing in dialysis clinics, informing the development of a targeted program. It addressed obstacles including system-level issues, unclear co-management, knowledge gaps, and patient preferences to improve medication management in this healthcare context.

The study encompassed 76 participants, with 53 clinicians and 23 patients, exploring factors impacting the deprescribing of inappropriate medications. Among clinicians, the majority were dialysis clinicians (n=24), followed by primary care (n=18) and pharmacists (n=11). Among the patients, a significant number were older than 65, exhibited cognitive impairment, and a considerable proportion were of Black race. The qualitative analysis yielded four major themes: system barriers such as limited electronic records and time, co-management ambiguity, limited medication knowledge for clinicians and patients, and patient preference for symptom control over risks. Clinicians anticipated resistance to deprescribing, while patients weighed benefits against risks. The findings emphasize the necessity of addressing these factors for effective deprescribing in dialysis clinics, offering insights into shared decision-making, caregiver involvement, and accommodating cognitive impairment. The study’s strength was diverse stakeholder representation. Limitations included that all participants were from a single geographic area and a need for As a guide for deprescribing moving forward, broader implementation of deprescribing should address these contextual factors.

Primary author Rasheeda Hall reflects on how the healthcare systems and institutions could utilize the study findings and insights to develop more effective and tailored deprescribing programs in various dialysis clinics:

“This study shows that siloed healthcare settings are a barrier to deprescribing. Healthcare systems and institutions can use this insight to promote seamless connection between healthcare settings to optimize medication reconciliation and communication between clinicians so there is current medication data and optimal co-management of medications in patients receiving dialysis.”

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