2022/10/18 by Sangil Lee, Morgan B. Swanson, Morgan Bobb Swanson +4 · 7 citations
Medicine · Nursing · #Acute care #Best practice #Context (archaeology) #Deprescribing #Emergency and Acute Care Studies #Emergency department #Family medicine #Focus group #Frailty in Older Adults #Geriatrics #Health care #Medical prescription #Medicine #Nursing #Pharmaceutical Practices and Patient Outcomes #Polypharmacy #Psychiatry #Psychological intervention #Qualitative research #Thematic analysis
paper · pdf · doi:10.1111/jgs.18047
openalex publication_date 2022/10/18 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
BACKGROUND: As the population of older adults increases, appropriate deprescribing becomes increasingly important for emergency geriatric care. Older adults represent the sickest patients with chronic medical conditions, and they are often exposed to high-risk medications. We need to provide an evidence-based, standardized deprescribing program in the acute care setting, yet the evidence base is lacking and standardized medication programs are needed. METHODS: We conducted a qualitative study with the goal to understand the perspective of healthcare workers, patients, and caregivers on deprescribing high-risk medications in the context of emergency care practices, provider preferences, and practice variability, along with the facilitators and barriers to an effective deprescribing program in the emergency department (ED). To ensure rich, contextual data, the study utilized two qualitative methods: (1) a focus group with physicians, advanced practice providers, nurses, pharmacists, and geriatricians involved in care of older adults and their prescriptions in the acute care setting; (2) semi-structured interviews with patients and caregivers involved in treatment and emergency care. Transcriptions were coded using thematic content analysis, and the principal investigator (S.L.) and trained research staff categorized each code into themes. RESULTS: Data collection from a focus group with healthcare workers (n = 8) and semi-structured interviews with patients and caregivers (n = 20) provided evidence of a potentially promising ED medication program, aligned with the vision of comprehensive care of older adults, that can be used to evaluate practices and develop interventions. We identified four themes: (1) Challenges in medication history taking, (2) missed opportunities in identifying high-risk medications, (3) facilitators and barriers to deprescribing recommendations, and (4) how to coordinate deprescribing recommendations. CONCLUSIONS: Our focus group and semi-structured interviews resulted in a framework for an ED medication program to screen, identify, and deprescribe high-risk medications for older adults and coordinate their care with primary care providers.