Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study
Background Patients on dialysis are commonly prescribed multiple medications (polypharmacy), many of which are potentially inappropriate medications (PIMs). PIMs are associated with an increased risk of falls, fractures, and hospitalization. Deprescribing is a promising intervention to reduce PIMs.M...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2024-12-01
|
| Series: | Health Literacy and Communication Open |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/28355245.2024.2399549 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850251457967685632 |
|---|---|
| author | Émilie Bortolussi-Courval Jimmy J. Lee Emilie Trinh Lisa M. McCarthy M. Battistella Ryan Hanula Todd C. Lee Kathleen Rice Emily G. McDonald |
| author_facet | Émilie Bortolussi-Courval Jimmy J. Lee Emilie Trinh Lisa M. McCarthy M. Battistella Ryan Hanula Todd C. Lee Kathleen Rice Emily G. McDonald |
| author_sort | Émilie Bortolussi-Courval |
| collection | DOAJ |
| description | Background Patients on dialysis are commonly prescribed multiple medications (polypharmacy), many of which are potentially inappropriate medications (PIMs). PIMs are associated with an increased risk of falls, fractures, and hospitalization. Deprescribing is a promising intervention to reduce PIMs.Methods We previously conducted a prospective controlled trial whereby we provided deprescribing decision support to nephrologists in one of two tertiary care outpatient hemodialysis units in Montreal, Canada. We aimed to collect information on barriers and facilitators to implementing deprescribing decision support with an electronic tool (MedSafer) by conducting semi-structured interviews among the four nephrologists who participated in the intervention arm of the study, between February and April 2023, following completion of the study. The four nephrologists had conducted medication reviews for a total of 68 patients on the intervention unit during the study. Interviews with participating nephrologists were conducted and transcribed by the study lead. Afterwards, data was coded and analyzed thematically with a focus on their perspective on participating in a quality improvement project during their clinical practice. Two graduate students used a combination of deductive (Theoretical Domains Framework) and inductive coding to analyze each transcribed interview in duplicate. Each coder then created a mind map to visually interpret results and derive themes. A senior qualitative researcher oversaw the development of the final common themes from the interviews.Results Four themes were developed: 1) the importance of deprescribing for patients on hemodialysis, 2) barriers to the success of the deprescribing intervention (e.g., the lack of a clinical pharmacist on the unit), 3) resources that were needed during the intervention (e.g., multidisciplinary team members to facilitate medication reconciliation), and 4) resources that facilitated the intervention (e.g., the provision of deprescribing brochures to patients).Conclusions This was the first study to explore the perspectives of nephrologists participating in a quality improvement project on deprescribing for patients on hemodialysis. This study interviewed a limited number of prescribers, which could limit the contextualized understanding and transferability of the nephrologists’ experiences. As a next step, some of the facilitators identified by the nephrologists should be implemented and studied in a larger clinical trial.Trial registration: NCT05585268 |
| format | Article |
| id | doaj-art-de45b05329ac4d5380a11000ec79e5db |
| institution | OA Journals |
| issn | 2835-5245 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Health Literacy and Communication Open |
| spelling | doaj-art-de45b05329ac4d5380a11000ec79e5db2025-08-20T01:57:54ZengTaylor & Francis GroupHealth Literacy and Communication Open2835-52452024-12-012110.1080/28355245.2024.2399549Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative studyÉmilie Bortolussi-Courval0Jimmy J. Lee1Emilie Trinh2Lisa M. McCarthy3M. Battistella4Ryan Hanula5Todd C. Lee6Kathleen Rice7Emily G. McDonald8Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, CanadaDivision of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, CanadaDivision of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, CanadaLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, CanadaLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, CanadaDivision of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, CanadaDivision of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, CanadaDivision of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, CanadaDivision of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, CanadaBackground Patients on dialysis are commonly prescribed multiple medications (polypharmacy), many of which are potentially inappropriate medications (PIMs). PIMs are associated with an increased risk of falls, fractures, and hospitalization. Deprescribing is a promising intervention to reduce PIMs.Methods We previously conducted a prospective controlled trial whereby we provided deprescribing decision support to nephrologists in one of two tertiary care outpatient hemodialysis units in Montreal, Canada. We aimed to collect information on barriers and facilitators to implementing deprescribing decision support with an electronic tool (MedSafer) by conducting semi-structured interviews among the four nephrologists who participated in the intervention arm of the study, between February and April 2023, following completion of the study. The four nephrologists had conducted medication reviews for a total of 68 patients on the intervention unit during the study. Interviews with participating nephrologists were conducted and transcribed by the study lead. Afterwards, data was coded and analyzed thematically with a focus on their perspective on participating in a quality improvement project during their clinical practice. Two graduate students used a combination of deductive (Theoretical Domains Framework) and inductive coding to analyze each transcribed interview in duplicate. Each coder then created a mind map to visually interpret results and derive themes. A senior qualitative researcher oversaw the development of the final common themes from the interviews.Results Four themes were developed: 1) the importance of deprescribing for patients on hemodialysis, 2) barriers to the success of the deprescribing intervention (e.g., the lack of a clinical pharmacist on the unit), 3) resources that were needed during the intervention (e.g., multidisciplinary team members to facilitate medication reconciliation), and 4) resources that facilitated the intervention (e.g., the provision of deprescribing brochures to patients).Conclusions This was the first study to explore the perspectives of nephrologists participating in a quality improvement project on deprescribing for patients on hemodialysis. This study interviewed a limited number of prescribers, which could limit the contextualized understanding and transferability of the nephrologists’ experiences. As a next step, some of the facilitators identified by the nephrologists should be implemented and studied in a larger clinical trial.Trial registration: NCT05585268https://www.tandfonline.com/doi/10.1080/28355245.2024.2399549Polypharmacydialysisdeprescribingdecision supportchronic renal insufficiency |
| spellingShingle | Émilie Bortolussi-Courval Jimmy J. Lee Emilie Trinh Lisa M. McCarthy M. Battistella Ryan Hanula Todd C. Lee Kathleen Rice Emily G. McDonald Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study Health Literacy and Communication Open Polypharmacy dialysis deprescribing decision support chronic renal insufficiency |
| title | Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study |
| title_full | Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study |
| title_fullStr | Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study |
| title_full_unstemmed | Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study |
| title_short | Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study |
| title_sort | use of medsafer electronic decision support for deprescribing in patients on hemodialysis a qualitative study |
| topic | Polypharmacy dialysis deprescribing decision support chronic renal insufficiency |
| url | https://www.tandfonline.com/doi/10.1080/28355245.2024.2399549 |
| work_keys_str_mv | AT emiliebortolussicourval useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT jimmyjlee useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT emilietrinh useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT lisammccarthy useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT mbattistella useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT ryanhanula useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT toddclee useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT kathleenrice useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy AT emilygmcdonald useofmedsaferelectronicdecisionsupportfordeprescribinginpatientsonhemodialysisaqualitativestudy |