Do care-home residents, doctors, nurses, and pharmacists agree on what matters most when stopping medications?

Details

Polypharmacy and multimorbidity are common in long-term care facilities (LTCFs). Reducing polypharmacy may reduce adverse events and maintain quality of life. Deprescribing means reducing medications after considering therapeutic goals, benefits and risks, and medical ethics.

This qualitative study used nominal group technique (NGT) to generate and then rank the factors that general medical practitioners (GPs), nurses, pharmacists, and residents or their representatives considered most important when deciding whether or not to deprescribe medications. Participants were invited if they worked with, or lived in, LTCFs across metropolitan and regional South Australia. Across six separate groups, participants included 11 residents or representatives, 19 GPs, 12 nurses and 14 pharmacists.

Separate groups of GPs, nurses, pharmacists, and residents or representatives were convened. Each group used NGT to rank the factors it considered most important in deciding whether or not to deprescribe. The factors prioritised by these individual groups were then discussed and prioritised using NGT in metropolitan and regional multidisciplinary groups comprising resident representatives, GPs, nurses and pharmacists.

No two groups had the same priorities. GPs ranked evidence for deprescribing and communication with the family or resident as most important. Nurses prioritised GPs’ receptivity to deprescribing and nurses’ ability to advocate for residents. Pharmacists prioritised the clinical appropriateness of therapy and identifying residents’ goals of care. Residents prioritised the wellbeing of the resident and continuity of nursing staff. The multidisciplinary groups prioritised the adequacy of medical and medication history and identifying residents’ goals of care.

Although each group prioritised different factors, both common and contrasting factors emerged. The researchers concluded that future deprescribing interventions need to consider the similarities and differences across the factors prioritised by residents and health professionals.