Exploring perceived barriers, facilitators, and team roles in addressing prescribing cascades in primary care teams: Insights from interprofessional focus groups
Bibliographic record
Abstract
BACKGROUND: Prescribing cascades are common contributors to medication-related harm. Primary care clinicians who practice in interprofessional teams may be well positioned to address cascades in practice; although, the factors that influence their ability to do so in this particular setting are largely unknown. Our study aimed to explore perceived barriers and facilitators that influence the identification, investigation, and management of prescribing cascades as experienced by primary care teams and each profession's role in addressing cascades. METHODS: Physicians, nurse practitioners, and pharmacists practicing in primary care teams in Ontario, Canada participated in a series of intra-professional and interprofessional focus groups. The focus groups explored clinician perspectives about factors that influence their ability to address cascades. Discussion and analyses were guided by the Theoretical Domains Framework and the Behaviour Change Wheel. RESULTS: Sixteen clinicians participated in four intra-professional and one interprofessional focus groups. Thematic analysis resulted in two main themes. First, multiple factors influenced primary care teams' ability to address prescribing cascades. Cascades were considered complex in terms of the processes required to identify, investigate, and manage them. Second, the role each profession was able or willing to play varied based on their capability, opportunity, and motivation. Nurse practitioners and physicians felt best equipped to prevent cascades within a patient visit, while pharmacists endorsed being able and willing to address existing cascades. CONCLUSION: The ability to address prescribing cascades is influenced by multiple factors and varied across professions within interprofessional primary care teams. The study findings provide additional information necessary for the design of future interventions to assist clinicians with addressing cascades. Future research should engage patients, caregivers, and community pharmacists to further explore their roles in addressing prescribing cascades.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.036 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.007 | 0.004 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".