Publication

Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents: A Qualitative Study

Wouters, H., Foster, J. M., Ensink, A., O'Donnell, L. K., Zuidema, S. U., Boersma, F. & Taxis, K., 18-Sep-2019, In : Frontiers in Pharmacology. 10, 12 p., 1026.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Wouters, H., Foster, J. M., Ensink, A., O'Donnell, L. K., Zuidema, S. U., Boersma, F., & Taxis, K. (2019). Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents: A Qualitative Study. Frontiers in Pharmacology, 10, [1026]. https://doi.org/10.3389/fphar.2019.01026

Author

Wouters, Hans ; Foster, Juliet M. ; Ensink, Anne ; O'Donnell, Lisa Kouladjian ; Zuidema, Sytse U. ; Boersma, Froukje ; Taxis, Katja. / Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents : A Qualitative Study. In: Frontiers in Pharmacology. 2019 ; Vol. 10.

Harvard

Wouters, H, Foster, JM, Ensink, A, O'Donnell, LK, Zuidema, SU, Boersma, F & Taxis, K 2019, 'Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents: A Qualitative Study', Frontiers in Pharmacology, vol. 10, 1026. https://doi.org/10.3389/fphar.2019.01026

Standard

Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents : A Qualitative Study. / Wouters, Hans; Foster, Juliet M.; Ensink, Anne; O'Donnell, Lisa Kouladjian; Zuidema, Sytse U.; Boersma, Froukje; Taxis, Katja.

In: Frontiers in Pharmacology, Vol. 10, 1026, 18.09.2019.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Wouters H, Foster JM, Ensink A, O'Donnell LK, Zuidema SU, Boersma F et al. Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents: A Qualitative Study. Frontiers in Pharmacology. 2019 Sep 18;10. 1026. https://doi.org/10.3389/fphar.2019.01026


BibTeX

@article{910d6adf383942cc989e32e44f809469,
title = "Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents: A Qualitative Study",
abstract = "Objectives: Inappropriate medication prescribing is a recognized clinical problem in nursing home residents of whom many have polypharmacy. However, results about the effectiveness of medication reviews targeted at improving prescribing and deprescribing have been equivocal. We therefore examined barriers and facilitators of conducting medication reviews.Method: We purposively sampled medication reviews to capture salient barriers and facilitators of conducting medication reviews both in nursing home care units for dementia and disabling conditions. We held semi-structured interviews about consecutive steps of medication reviews. Interviews were transcribed verbatim and analyzed with the {"}method of constant comparison.{"}Results: Six nursing home residents/relatives of nursing home residents, 8 elder care physicians, 5 pharmacists, and 10 nurses took part in the semi-structured interviews. We observed four overarching themes of barriers and facilitators: {"}realizing fidelity of the patient perspective (theme 1),{"} {"}level of comprehensiveness of medication reviews (theme 2),{"} {"}inclinations of healthcare providers (theme 3),{"} and {"}inter-professional collaboration and alliances (theme 4).{"} Theme 1 {"}realizing fidelity of the patient perspective{"} referred to the observation that assessing the patient perspective was a delicate balance between the value and the impediments of a proper assessment of the patient perspective. Theme 2 {"}level of comprehensiveness of medication reviews{"} reflected the struggle of practitioners to find an optimum between medication reviews being both comprehensive and feasible. Theme 3 {"}inclinations of healthcare providers{"} concerned setting intervention targets that were complementary to the practices of physicians and keeping the pharmacist blind to the patient perspective as a countermeasure to physicians' inclinations. Finally, theme 4 {"}inter-professional collaboration and alliances{"} highlighted mutual support and inter-professional collaboration to strengthen healthcare practitioners' contributions.Discussion: These themes of barriers and facilitators emphasize the need to improve meta-communication during the medication review process. This pertains to the need for healthcare providers to appraise the fidelity of the patient perspective in a dialogue with residents/relatives. Furthermore, discourse between healthcare practitioners is needed beforehand about the level of comprehensiveness intervention targets, and inter-professional collaboration.",
keywords = "polypharmacy, inappropriate prescribing, semi-structured interviews, deprescribing, geriatrics, qualitative study, inter-professional collaboration, medication reviews, OLDER-PEOPLE, PHARMACEUTICAL CARE, SCREENING TOOL, ALERT DOCTORS, INTERVENTION, PERSPECTIVES, PHARMACIST, MEDICINES, CRITERIA",
author = "Hans Wouters and Foster, {Juliet M.} and Anne Ensink and O'Donnell, {Lisa Kouladjian} and Zuidema, {Sytse U.} and Froukje Boersma and Katja Taxis",
year = "2019",
month = "9",
day = "18",
doi = "10.3389/fphar.2019.01026",
language = "English",
volume = "10",
journal = "Frontiers in Pharmacology",
issn = "1663-9812",
publisher = "Frontiers Media SA",

}

RIS

TY - JOUR

T1 - Barriers and Facilitators of Conducting Medication Reviews in Nursing Home Residents

T2 - A Qualitative Study

AU - Wouters, Hans

AU - Foster, Juliet M.

AU - Ensink, Anne

AU - O'Donnell, Lisa Kouladjian

AU - Zuidema, Sytse U.

AU - Boersma, Froukje

AU - Taxis, Katja

PY - 2019/9/18

Y1 - 2019/9/18

N2 - Objectives: Inappropriate medication prescribing is a recognized clinical problem in nursing home residents of whom many have polypharmacy. However, results about the effectiveness of medication reviews targeted at improving prescribing and deprescribing have been equivocal. We therefore examined barriers and facilitators of conducting medication reviews.Method: We purposively sampled medication reviews to capture salient barriers and facilitators of conducting medication reviews both in nursing home care units for dementia and disabling conditions. We held semi-structured interviews about consecutive steps of medication reviews. Interviews were transcribed verbatim and analyzed with the "method of constant comparison."Results: Six nursing home residents/relatives of nursing home residents, 8 elder care physicians, 5 pharmacists, and 10 nurses took part in the semi-structured interviews. We observed four overarching themes of barriers and facilitators: "realizing fidelity of the patient perspective (theme 1)," "level of comprehensiveness of medication reviews (theme 2)," "inclinations of healthcare providers (theme 3)," and "inter-professional collaboration and alliances (theme 4)." Theme 1 "realizing fidelity of the patient perspective" referred to the observation that assessing the patient perspective was a delicate balance between the value and the impediments of a proper assessment of the patient perspective. Theme 2 "level of comprehensiveness of medication reviews" reflected the struggle of practitioners to find an optimum between medication reviews being both comprehensive and feasible. Theme 3 "inclinations of healthcare providers" concerned setting intervention targets that were complementary to the practices of physicians and keeping the pharmacist blind to the patient perspective as a countermeasure to physicians' inclinations. Finally, theme 4 "inter-professional collaboration and alliances" highlighted mutual support and inter-professional collaboration to strengthen healthcare practitioners' contributions.Discussion: These themes of barriers and facilitators emphasize the need to improve meta-communication during the medication review process. This pertains to the need for healthcare providers to appraise the fidelity of the patient perspective in a dialogue with residents/relatives. Furthermore, discourse between healthcare practitioners is needed beforehand about the level of comprehensiveness intervention targets, and inter-professional collaboration.

AB - Objectives: Inappropriate medication prescribing is a recognized clinical problem in nursing home residents of whom many have polypharmacy. However, results about the effectiveness of medication reviews targeted at improving prescribing and deprescribing have been equivocal. We therefore examined barriers and facilitators of conducting medication reviews.Method: We purposively sampled medication reviews to capture salient barriers and facilitators of conducting medication reviews both in nursing home care units for dementia and disabling conditions. We held semi-structured interviews about consecutive steps of medication reviews. Interviews were transcribed verbatim and analyzed with the "method of constant comparison."Results: Six nursing home residents/relatives of nursing home residents, 8 elder care physicians, 5 pharmacists, and 10 nurses took part in the semi-structured interviews. We observed four overarching themes of barriers and facilitators: "realizing fidelity of the patient perspective (theme 1)," "level of comprehensiveness of medication reviews (theme 2)," "inclinations of healthcare providers (theme 3)," and "inter-professional collaboration and alliances (theme 4)." Theme 1 "realizing fidelity of the patient perspective" referred to the observation that assessing the patient perspective was a delicate balance between the value and the impediments of a proper assessment of the patient perspective. Theme 2 "level of comprehensiveness of medication reviews" reflected the struggle of practitioners to find an optimum between medication reviews being both comprehensive and feasible. Theme 3 "inclinations of healthcare providers" concerned setting intervention targets that were complementary to the practices of physicians and keeping the pharmacist blind to the patient perspective as a countermeasure to physicians' inclinations. Finally, theme 4 "inter-professional collaboration and alliances" highlighted mutual support and inter-professional collaboration to strengthen healthcare practitioners' contributions.Discussion: These themes of barriers and facilitators emphasize the need to improve meta-communication during the medication review process. This pertains to the need for healthcare providers to appraise the fidelity of the patient perspective in a dialogue with residents/relatives. Furthermore, discourse between healthcare practitioners is needed beforehand about the level of comprehensiveness intervention targets, and inter-professional collaboration.

KW - polypharmacy

KW - inappropriate prescribing

KW - semi-structured interviews

KW - deprescribing

KW - geriatrics

KW - qualitative study

KW - inter-professional collaboration

KW - medication reviews

KW - OLDER-PEOPLE

KW - PHARMACEUTICAL CARE

KW - SCREENING TOOL

KW - ALERT DOCTORS

KW - INTERVENTION

KW - PERSPECTIVES

KW - PHARMACIST

KW - MEDICINES

KW - CRITERIA

U2 - 10.3389/fphar.2019.01026

DO - 10.3389/fphar.2019.01026

M3 - Article

VL - 10

JO - Frontiers in Pharmacology

JF - Frontiers in Pharmacology

SN - 1663-9812

M1 - 1026

ER -

ID: 97865148