Use of MedSafer electronic decision support for deprescribing in patients on hemodialysis: a qualitative study
Notice bibliographique
Résumé
Background Patients on dialysis are commonly prescribed multiple medications (polypharmacy), many of which are potentially inappropriate medications (PIMs). PIMs are associated with an increased risk of falls, fractures, and hospitalization. Deprescribing is a promising intervention to reduce PIMs.Methods We previously conducted a prospective controlled trial whereby we provided deprescribing decision support to nephrologists in one of two tertiary care outpatient hemodialysis units in Montreal, Canada. We aimed to collect information on barriers and facilitators to implementing deprescribing decision support with an electronic tool (MedSafer) by conducting semi-structured interviews among the four nephrologists who participated in the intervention arm of the study, between February and April 2023, following completion of the study. The four nephrologists had conducted medication reviews for a total of 68 patients on the intervention unit during the study. Interviews with participating nephrologists were conducted and transcribed by the study lead. Afterwards, data was coded and analyzed thematically with a focus on their perspective on participating in a quality improvement project during their clinical practice. Two graduate students used a combination of deductive (Theoretical Domains Framework) and inductive coding to analyze each transcribed interview in duplicate. Each coder then created a mind map to visually interpret results and derive themes. A senior qualitative researcher oversaw the development of the final common themes from the interviews.Results Four themes were developed: 1) the importance of deprescribing for patients on hemodialysis, 2) barriers to the success of the deprescribing intervention (e.g., the lack of a clinical pharmacist on the unit), 3) resources that were needed during the intervention (e.g., multidisciplinary team members to facilitate medication reconciliation), and 4) resources that facilitated the intervention (e.g., the provision of deprescribing brochures to patients).Conclusions This was the first study to explore the perspectives of nephrologists participating in a quality improvement project on deprescribing for patients on hemodialysis. This study interviewed a limited number of prescribers, which could limit the contextualized understanding and transferability of the nephrologists’ experiences. As a next step, some of the facilitators identified by the nephrologists should be implemented and studied in a larger clinical trial.Trial registration: NCT05585268
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».