Cited by 16Pharmaceutical Practices and Patient OutcomesEmergency and Acute Care StudiesOpioid Use Disorder Treatment

Challenges and opportunities in creating a deprescribing program in the emergency department: A qualitative study

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Lee, Sangil, Bobb Swanson, Morgan, Fillman, Allison, Carnahan, Ryan M., Seaman, Aaron T., Reisinger, Heather Schacht·2023·Journal of the American Geriatrics Society

Abstract

Background: As the population of older adults increases, appropriate deprescribing becomes increasingly important for emergency geriatric care. Older adults represent the sickest patients with chronic medical conditions, and they are often exposed to high‐risk medications. We need to provide an evidence‐based, standardized deprescribing program in the acute care setting, yet the evidence base is lacking and standardized medication programs are needed. Methods: We conducted a qualitative study with the goal to understand the perspective of healthcare workers, patients, and caregivers on deprescribing high‐risk medications in the context of emergency care practices, provider preferences, and practice variability, along with the facilitators and barriers to an effective deprescribing program in the emergency department (ED). To ensure rich, contextual data, the study utilized two qualitative methods: (1) a focus group with physicians, advanced practice providers, nurses, pharmacists, and geriatricians involved in care of older adults and their prescriptions in the acute care setting; (2) semi‐structured interviews with patients and caregivers involved in treatment and emergency care. Transcriptions were coded using thematic content analysis, and the principal investigator (S.L.) and trained research staff categorized each code into themes. Results: Data collection from a focus group with healthcare workers ( n = 8) and semi‐structured interviews with patients and caregivers ( n = 20) provided evidence of a potentially promising ED medication program, aligned with the vision of comprehensive care of older adults, that can be used to evaluate practices and develop interventions. We identified four themes: (1) Challenges in medication history taking , (2) missed opportunities in identifying high‐risk medications , (3) facilitators and barriers to deprescribing recommendations , and (4) how to coordinate deprescribing recommendations. Conclusions: Our focus group and semi‐structured interviews resulted in a framework for an ED medication program to screen, identify, and deprescribe high‐risk medications for older adults and coordinate their care with primary care providers.

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  • Explicit criterion-based deprescribing assessments such as STOPP and Beers are often impractical to implement in time-constrained clinical settings such as the emergency department due to the need to evaluate multiple clinical indications and specialist-prescribed medications.

    “These explicit assessments are criterion-based with clear standards but are often impractical to implement in time-constrained clinical settings, such as ED, due to the need to evaluate multiple clinical indications and specialist-prescribed medications [10].”

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  1. [3]National Prevention Council. Healthy Aging in Action: Advancing the National Prevention Strategy. Publications and Reports of the Surgeon General; 2016. 30896903

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Authors
Lee, S., Bobb Swanson, M., Fillman, A., Carnahan, R. M., Seaman, A. T., & Reisinger, H. S.
Affiliations
  • University of Iowa (US)
  • Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
Corresponding author
Lee, Sangil
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2022-10-18
Volume
71
Issue
1
Pages
62-76
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
OpenAlex
W4306756957
Cited by
16
References
72
Citations by year
2026: 6 · 2025: 6 · 2024: 2 · 2023: 1 · 2022: 1
FWCI
1.43
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Geriatrics Society (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Roy J. and Lucille A. Carver College of Medicine, University of Iowa
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
deprescribing, emergency department, older adults, high-risk medications, medication history taking, barriers to deprescribing, care coordination, primary care, patient and caregiver perspectives, healthcare worker perspectives, acute care
MeSH terms
Deprescriptions, Aged, Emergency Service, Hospital, Humans, Physicians, Focus Groups, Qualitative Research

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