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Table 3 Preferences for Interventions to Improve Ability to Deprescribe Medications

From: Supporting medication discontinuation: provider preferences for interventions to facilitate deprescribing

 

First Choice

Second Choice

Third Choice

All Respondents

 All (326)

Indication for use

Assistance with follow-up

Patient involvement

Age

 <49 years (118)

Indication for use

Assistance with follow-up

Information exchange with all pharmacies

 50–59 years (120)

Indication for use

Assistance with follow-up

Patient involvement

 ≥60 years (83)

Indication for use

Patient involvement

Assistance with follow-up

Gender

 Male (151)

Indication for use

Assistance with follow-up

Patient involvement

 Female (165)

Assistance with follow-up

Indication for use

Patient involvement

Race

 White (235)

Assistance with follow-up

Indication for use

Patient involvement

 Non-White (81)

Indication for use

Patient involvement

Clinical decision support

Provider type

 Physician (243)

Indication for use

Assistance with follow-up

Patient involvement

 Nurse Practitioner or Physician Assistant (53)

Indication for use

Assistance with follow-up

Patient involvement

 Clinical Pharmacy Specialist (30)

Indication for use

Information exchange with all pharmacies

Improved information exchange with providers located at community facilities

Number of clinic sessions per week

 ≤7 (148)

Assistance with follow-up

Indication for use

Patient involvement

 8–10 (167)

Indication for use

Patient involvement

Assistance with follow-up

Number of years working in VA

 ≤4 (94)

Indication for use

Information exchange with all pharmacies

Assistance with follow-up

 5–9 (80)

Assistance with follow-up

Indication for use

Patient involvement

 ≥10 (146)

Indication for use

Assistance with follow-up

Patient involvement

Prior experience working in a non-VA setting

 Yes (250)

Indication for use

Assistance with follow-up

Patient involvement

 No (69)

Assistance with follow-up

Patient involvement

Indication for use

Self-rated comfort with medication discontinuation (0–10 scale)

 Low, 0–6 (83)

Assistance with follow-up

Indication for use

Information exchange with all pharmacies

 Medium, 7–8 (126)

Assistance with follow-up

Indication for use

Patient involvement

 High 9–10 (108)

Indication for use

Assistance with follow-up

Information exchange with all pharmacies

Beliefs about medication overuse

 Neutral/disagree/strongly disagree (288)

Indication for use

Assistance with follow-up

Patient involvement

 Agree/strongly agree (38)

Patient involvement

Indication for use

Information exchange with all pharmacies

Perceptions of patients’ ability to manage their own health

 Less (223)

Indication for use

Assistance with follow-up

Patient involvement

 More (101)

Indication for use

Patient involvement

Assistance with follow-up

Frequency of experiencing uncertainty about the indication for a patient’s medication

 Never/Rarely (83)

Indication for use

Assistance with follow-up

Information exchange with all pharmacies

 Sometimes (173)

Assistance with follow-up

Indication for use

Patient involvement

 Often/Usually (68)

Indication for use

Patient involvement

Assistance with follow-up

Experience with discontinuing medications initiated by other providers

 Never/rarely (46)

Patient involvement

Indication for use

Clinical decision support

 Sometimes (271)

Indication for use

Assistance with follow-up

Patient involvement

 Often/usually (8)

Assistance with follow-up

Indication for use

Patient involvement

Experience with patient activation

 Low (117)

Indication for use

Assistance with follow-up

Information exchange with all pharmacies

 Medium (108)

Assistance with follow-up

Indication for use

Patient involvement

 High (97)

Patient involvement

Indication for use

Assistance with follow-up

  1. Indication for use = Requiring all medication prescriptions to have an associated “indication for use”
  2. Assistance with follow-up = Assistance with follow-up of patients as they taper of discontinue medications is performed by another member of the Patient Aligned Care Team (PACT)
  3. Patient involvement = Increased Patient involvement in prescribing decisions
  4. Information exchange with all pharmacies = Improved information exchange with all VA and non-VA pharmacies to confirm medication reconciliation
  5. Clinical decision support = Use of clinical decision support tools, such as drug-drug alerts, within the electronic health record