TY - JOUR
T1 - Intervention design in cognitively impaired populations—Lessons learned from the OPTIMIZE deprescribing pragmatic trial
AU - Sheehan, Orla C.
AU - Gleason, Kathy S.
AU - Bayliss, Elizabeth A.
AU - Green, Ariel R.
AU - Drace, Melanie L.
AU - Norton, Jonathan
AU - Reeve, Emily
AU - Shetterly, Susan M.
AU - Weffald, Linda A.
AU - Sawyer, Jennifer K.
AU - Maciejewski, Matthew L.
AU - Kraus, Courtney
AU - Maiyani, Mahesh
AU - Wolff, Jennifer
AU - Boyd, Cynthia M.
N1 - Funding Information:
Drs Bayliss, Gleason, Green, Maciejewski, Sheehan, Wolff, and Boyd; Mss Shetterly, Drace, Sawyer, Weffald, and Kraus; and Messrs Norton and Maiyani reported receiving grants from the National Institute on Aging during the conduct of the study. Dr Reeve reported receiving grants from the National Institutes of Health and royalties from UpToDate for writing a chapter on deprescribing. Dr Green reported receiving grants from the National Institute on Aging Impact Collaboratory during the conduct of the study. Dr Maciejewski reported receiving Veterans Affairs Health Services Research and Development funding and owning Amgen stock due to his spouse's employment. Dr Boyd reported receiving royalties from UpToDate for writing a chapter on multimorbidity and honoraria from Dynamed for reviewing a chapter on falls outside the submitted work. No other disclosures were reported.
Publisher Copyright:
© 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Polypharmacy is common in older adults with cognitive impairment and multiple chronic conditions, increasing risks of adverse drug events, hospitalization, and death. Deprescribing, the process of reducing or stopping potentially inappropriate medications, may improve outcomes. The OPTIMIZE pragmatic trial examined whether educating and activating patients, family members and clinicians about deprescribing reduces number of chronic medications and potentially inappropriate medications. Acceptability and challenges of intervention delivery in cognitively impaired older adults are not well understood. Methods: We explored mechanisms of intervention implementation through post hoc qualitative interviews and surveys with stakeholder groups of 15 patients, 7 caregivers, and 28 clinicians. We assessed the context in which the intervention was delivered, its implementation, and mechanisms of impact. Results: Acceptance of the intervention was affected by contextual factors including cognition, prior knowledge of deprescribing, communication, and time constraints. All stakeholder groups endorsed the acceptability, importance, and delivery of the intervention. Positive mechanisms of impact included patients scheduling specific appointments to discuss deprescribing and providers being prompted to consider deprescribing. Recollection of intervention materials was inconsistent but most likely shortly after intervention delivery. Short visit times remained the largest provider barrier to deprescribing. Conclusions: Our work identifies key learnings in intervention delivery that can guide future scaling of deprescribing interventions in this population. We highlight the critical roles of timing and repetition in intervention delivery to cognitively impaired populations and the barrier posed by short consultation times. The acceptability of the intervention to patients and family members highlights the potential to incorporate deprescribing education into routine clinical practice and expand proven interventions to other vulnerable populations.
AB - Background: Polypharmacy is common in older adults with cognitive impairment and multiple chronic conditions, increasing risks of adverse drug events, hospitalization, and death. Deprescribing, the process of reducing or stopping potentially inappropriate medications, may improve outcomes. The OPTIMIZE pragmatic trial examined whether educating and activating patients, family members and clinicians about deprescribing reduces number of chronic medications and potentially inappropriate medications. Acceptability and challenges of intervention delivery in cognitively impaired older adults are not well understood. Methods: We explored mechanisms of intervention implementation through post hoc qualitative interviews and surveys with stakeholder groups of 15 patients, 7 caregivers, and 28 clinicians. We assessed the context in which the intervention was delivered, its implementation, and mechanisms of impact. Results: Acceptance of the intervention was affected by contextual factors including cognition, prior knowledge of deprescribing, communication, and time constraints. All stakeholder groups endorsed the acceptability, importance, and delivery of the intervention. Positive mechanisms of impact included patients scheduling specific appointments to discuss deprescribing and providers being prompted to consider deprescribing. Recollection of intervention materials was inconsistent but most likely shortly after intervention delivery. Short visit times remained the largest provider barrier to deprescribing. Conclusions: Our work identifies key learnings in intervention delivery that can guide future scaling of deprescribing interventions in this population. We highlight the critical roles of timing and repetition in intervention delivery to cognitively impaired populations and the barrier posed by short consultation times. The acceptability of the intervention to patients and family members highlights the potential to incorporate deprescribing education into routine clinical practice and expand proven interventions to other vulnerable populations.
KW - cognitive impairment
KW - deprescribing
KW - intervention delivery
UR - http://www.scopus.com/inward/record.url?scp=85150336363&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150336363&partnerID=8YFLogxK
U2 - 10.1111/jgs.18148
DO - 10.1111/jgs.18148
M3 - Article
C2 - 36508725
AN - SCOPUS:85150336363
SN - 0002-8614
VL - 71
SP - 774
EP - 784
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 3
ER -