Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review
Abstract Background Tackling problematic polypharmacy requires tailoring the use of medicines to individual circumstances and may involve the process of deprescribing. Deprescribing can cause anxiety and concern for clinicians and patients. Tailoring medication decisions often entails beyond protoco...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-022-02475-1 |
| _version_ | 1798004282319962112 |
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| author | Amadea Turk Geoffrey Wong Kamal R. Mahtani Michelle Madden Ruaraidh Hill Ed Ranson Emma Wallace Janet Krska Dee Mangin Richard Byng Daniel Lasserson Joanne Reeve |
| author_facet | Amadea Turk Geoffrey Wong Kamal R. Mahtani Michelle Madden Ruaraidh Hill Ed Ranson Emma Wallace Janet Krska Dee Mangin Richard Byng Daniel Lasserson Joanne Reeve |
| author_sort | Amadea Turk |
| collection | DOAJ |
| description | Abstract Background Tackling problematic polypharmacy requires tailoring the use of medicines to individual circumstances and may involve the process of deprescribing. Deprescribing can cause anxiety and concern for clinicians and patients. Tailoring medication decisions often entails beyond protocol decision-making, a complex process involving emotional and cognitive work for healthcare professionals and patients. We undertook realist review to highlight and understand the interactions between different factors involved in deprescribing and to develop a final programme theory that identifies and explains components of good practice that support a person-centred approach to deprescribing in older patients with multimorbidity and polypharmacy. Methods The realist approach involves identifying underlying causal mechanisms and exploring how, and under what conditions they work. We conducted a search of electronic databases which were supplemented by citation checking and consultation with stakeholders to identify other key documents. The review followed the key steps outlined by Pawson et al. and followed the RAMESES standards for realist syntheses. Results We included 119 included documents from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) and a final programme theory. Our programme theory recognises that deprescribing is a complex intervention influenced by a multitude of factors. The components of our final programme theory include the following: a supportive infrastructure that provides clear guidance around professional responsibilities and that enables multidisciplinary working and continuity of care, consistent access to high-quality relevant patient contextual data, the need to support the creation of a shared explanation and understanding of the meaning and purpose of medicines and a trial and learn approach that provides space for monitoring and continuity. These components may support the development of trust which may be key to managing the uncertainty and in turn optimise outcomes. These components are summarised in the novel DExTruS framework. Conclusion Our findings recognise the complex interpretive practice and decision-making involved in medication management and identify key components needed to support best practice. Our findings have implications for how we design medication review consultations, professional training and for patient records/data management. Our review also highlights the role that trust plays both as a central element of tailored prescribing and a potential outcome of good practice in this area. |
| first_indexed | 2024-04-11T12:21:09Z |
| format | Article |
| id | doaj.art-184dd8799c004a6185e94a0e44fe7d55 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-11T12:21:09Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-184dd8799c004a6185e94a0e44fe7d552022-12-22T04:24:05ZengBMCBMC Medicine1741-70152022-08-0120111810.1186/s12916-022-02475-1Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist reviewAmadea Turk0Geoffrey Wong1Kamal R. Mahtani2Michelle Madden3Ruaraidh Hill4Ed Ranson5Emma Wallace6Janet Krska7Dee Mangin8Richard Byng9Daniel Lasserson10Joanne Reeve11Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of OxfordNuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of OxfordNuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of OxfordLiverpool Reviews & Implementation Group, Institute of Population Health, University of LiverpoolLiverpool Reviews & Implementation Group, Institute of Population Health, University of LiverpoolAcademy of Primary Care, Hull York Medical School, Allam Medical Building, University of HullDepartment of General Practice RCSI University of Medicine and Health SciencesMedway School of Pharmacy, Universities of Greenwich and KentDepartment of Family Medicine, McMaster UniversityCommunity and Primary Care Research Group, Peninsula Medical School, University of PlymouthHealth Sciences, Warwick Medical School, University of WarwickAcademy of Primary Care, Hull York Medical School, Allam Medical Building, University of HullAbstract Background Tackling problematic polypharmacy requires tailoring the use of medicines to individual circumstances and may involve the process of deprescribing. Deprescribing can cause anxiety and concern for clinicians and patients. Tailoring medication decisions often entails beyond protocol decision-making, a complex process involving emotional and cognitive work for healthcare professionals and patients. We undertook realist review to highlight and understand the interactions between different factors involved in deprescribing and to develop a final programme theory that identifies and explains components of good practice that support a person-centred approach to deprescribing in older patients with multimorbidity and polypharmacy. Methods The realist approach involves identifying underlying causal mechanisms and exploring how, and under what conditions they work. We conducted a search of electronic databases which were supplemented by citation checking and consultation with stakeholders to identify other key documents. The review followed the key steps outlined by Pawson et al. and followed the RAMESES standards for realist syntheses. Results We included 119 included documents from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) and a final programme theory. Our programme theory recognises that deprescribing is a complex intervention influenced by a multitude of factors. The components of our final programme theory include the following: a supportive infrastructure that provides clear guidance around professional responsibilities and that enables multidisciplinary working and continuity of care, consistent access to high-quality relevant patient contextual data, the need to support the creation of a shared explanation and understanding of the meaning and purpose of medicines and a trial and learn approach that provides space for monitoring and continuity. These components may support the development of trust which may be key to managing the uncertainty and in turn optimise outcomes. These components are summarised in the novel DExTruS framework. Conclusion Our findings recognise the complex interpretive practice and decision-making involved in medication management and identify key components needed to support best practice. Our findings have implications for how we design medication review consultations, professional training and for patient records/data management. Our review also highlights the role that trust plays both as a central element of tailored prescribing and a potential outcome of good practice in this area.https://doi.org/10.1186/s12916-022-02475-1Realist reviewEvidence synthesisDeprescribingPolypharmacyPerson-centred care |
| spellingShingle | Amadea Turk Geoffrey Wong Kamal R. Mahtani Michelle Madden Ruaraidh Hill Ed Ranson Emma Wallace Janet Krska Dee Mangin Richard Byng Daniel Lasserson Joanne Reeve Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review BMC Medicine Realist review Evidence synthesis Deprescribing Polypharmacy Person-centred care |
| title | Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review |
| title_full | Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review |
| title_fullStr | Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review |
| title_full_unstemmed | Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review |
| title_short | Optimising a person-centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the DExTruS framework: a realist review |
| title_sort | optimising a person centred approach to stopping medicines in older people with multimorbidity and polypharmacy using the dextrus framework a realist review |
| topic | Realist review Evidence synthesis Deprescribing Polypharmacy Person-centred care |
| url | https://doi.org/10.1186/s12916-022-02475-1 |
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