A man attends a routine appointment with the same physician who’s seen him for 10 years. During his visit, the doctor abruptly informs him that she is discontinuing a medication that has helped him manage chronic pain for several years. When he expresses concern and questions her decision, the doctor reiterates that she will no longer refill his prescription. The man leaves the appointment feeling dismissed and anxious about his condition.
Have you ever been part of a similar situation (as a provider, patient, or caregiver)? Unfortunately, it’s both common and unnecessary. Deprescribing is a safe practice that can address the challenges of polypharmacy, but health care providers don’t always take the time necessary to adequately explain the concept or its benefits to patients. During the September 13 WIHI audio program, panelists and participants noted that communication with patients may hold the keys to making deprescribing an effective process that meets their health goals. They shared insights about how to partner with patients to make the process work.
Focus on What Matters to Patients and their Families
Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP, Executive Director, Peter Lamy Center on Drug Therapy and Aging, advised clinicians to start the deprescribing process by learning as much as they can about their patients. Ask about their health goals, level of functioning, and treatment preferences to help develop a health care plan based on their specific needs.
Panelists also noted that many patients wish they could be on fewer medications. As IHI’s Chief Operations and North America Programs Officer Trissa Torres, MD, noted, “Asking what [medications] matter most to them and why seems like a good place to start.” Understanding patients’ individual medical needs is key to meeting them where they are and delivering appropriate care.
Address Fears and Concerns
Discontinuing medications can alarm patients who aren’t familiar with deprescribing, especially when their prescriptions have helped them maintain their health goals for many years. Lynn Deguzman, PharmD, BCGP, Regional Clinical Operations Manager, Kaiser Permanente noted that a lack of clear communication can lead to mistrust toward clinicians.
To assuage the concerns of patients, Kaiser Permanente staff partnered with health educators to explain why their medications had become unnecessary or potentially harmful. They also pointed to research indicating the need to reevaluate medication therapy. In addition, the team reassured patients that they would follow up within two weeks and offered the option to return to their medication if they were not reaching their health goals. This encouraged patients to participate in the program and helped them feel more secure.
Engage Patients as Partners
Florian Daragjati, PharmD, BCPS, Director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention, stressed the importance of engaging patients as partners in decision-making. Clinicians should explain to patients and families why they recommend discontinuing their medication. Patients and providers should establish health goals together. This especially important, he noted, prior to surgical procedures or after acute medical episodes.
Dr. Torres cautioned against top-down communication, advocating for lateral dialogue between patients and providers. “When we talk about ‘literacy,’” she pointed out, “it seems we often focus on helping assure the patients understand our thinking.” Instead, she asserted, clinicians should be trying to understand what patients are thinking. “If we focus on listening and understanding,” she explained, “we can make our conversation contextually relevant to [the patient].”
Joshua Eng is IHI’s Content Marketing Project Assistant.
You may also be interested in:
WIHI: The How and Why of Deprescribing
Innovation case study: Reducing Inappropriate Medication Use by Implementing Deprescribing Guidelines
Deprescribing Can Mean Fewer Opioids, More Grateful Patients
Deprescribing: Is Less Medicine the Best Medicine?
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