Motivating deprescribing conversations for patients with Alzheimer's disease and related dementias: a descriptive study.

Mary T Antonelli, John S Cox, Cassandra Saphirak, Jerry H Gurwitz, Sonal Singh, Kathleen M Mazor

Abstract read

In one paragraph

Article in Therapeutic advances in drug safety, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it

0cells of the map it votes in

4citing papers in PubMed, 1 pooled it

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Mary T AntonelliTan Chingfen Graduate School of Nursing, University of Massachusetts Chan Medical School, 55 N. Lake Ave., Worcester, MA 01655-0112, USA.ORCID https://orcid.org/0000-0002-8604-6805

John S CoxMeyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.

Cassandra SaphirakMeyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.

Jerry H GurwitzMeyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.

Sonal SinghMeyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.ORCID https://orcid.org/0000-0003-0912-941X

Kathleen M MazorUniversity of Massachusetts Chan Medical School and Meyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.

Funding

Developing a PRogram to Educate and Sensitize Caregivers to Reduce the Inappropriate Prescription Burden in Elderly with Alzheimer's Disease Study (D-PRESCRIBE-AD)R33AG069794 · NIA · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI GURWITZ, JERRY H · 2021 to 2024

$4.0M

NIA NIH HHS R33 AG069794

6 · The paper itself

Abstract

Introduction: Older adults with Alzheimer's disease and related dementias (ADRD) are at increased risk of harm due to prescribing of potentially inappropriate medications. Encouraging patients and caregivers to talk with their providers about potentially inappropriate medications could stimulate deprescribing. Our objective was to explore whether mailing educational materials to patients with ADRD might activate patients or caregivers to initiate a conversation with their provider about potentially inappropriate medications. Methods: We conducted semi-structured interviews with patients with ADRD, caregivers of patients with ADRD, and healthcare providers. All participants were shown educational materials referencing potentially inappropriate medications and suggestions to promote deprescribing. Interviews explored reactions to the materials, the idea of patients and caregivers initiating a conversation about deprescribing, and the deprescribing process. Interview transcripts were analyzed using inductive thematic analysis. Results: We conducted a total of 27 interviews: 9 with caregivers only, 2 with patients only, 3 with patient-caregiver dyads, and 13 with providers. Patients and caregivers reported that if a medication might cause harm, it would motivate them to talk to their provider about the medication. Trust in the provider could facilitate or inhibit such conversations; conversations would be more likely if there were prior positive experiences asking questions of the provider. Providers were receptive to patients and caregivers initiating conversations about their medications, as they valued deprescribing as part of their clinical practice and welcome informed patients and caregivers as participants in decision-making about medication. Conclusion: Mailing educational materials about potentially inappropriate medications to community-dwelling patients with ADRD may promote deprescribing conversations. Ongoing pragmatic trials will determine whether such interventions stimulate deprescribing conversations and achieve reductions in prescribing of inappropriate medications. Plain Language Summary:

Indexed as

Alzheimer’s disease and related dementiasdeprescribingeducational mailingspatient–caregiver activation

Identifiers

PMID36052398

DOI10.1177/20420986221118143

PMCPMC9425903

What Socratic holds

Textmetadata

LicenceCC BY-NC

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.