Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study

BMC Geriatrics

Hannah Irving¹  Barbara J. Farrell²  Lianne Jeffs³  Lisa M. McCarthy⁴ 

[1] Bruyère Research Institute, 43 Bruyère St, K1N 5C8, Ottawa, Ontario, Canada;Bruyère Research Institute, 43 Bruyère St, K1N 5C8, Ottawa, Ontario, Canada;Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada;School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada;Lunenfeld-Tanenbaum Research Institute Sinai Health System, Toronto, Ontario, Canada;Institute of Health Policy Management and Evaluation & Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada;Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada;Leslie Dan Faculty of Pharmacy and Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada;

关键词: Prescribing cascade;    Problematic polypharmacy;    Drug therapy;    Older adults;   

DOI  :  10.1186/s12877-020-01774-7

来源: Springer

【 摘 要 】

BackgroundPrescribing cascades occur when the side effect of a medication is treated with a second medication. The aim of the study was to understand how prescribing cascades develop and persist and to identify strategies for their identification, prevention and management.MethodThis qualitative study employed semi-structured interviews to explore the existence of prescribing cascades and to gather patients', caregivers' and clinicians’ perspectives about how prescribing cascades start, persist and how they might be resolved. Participants were older adults (over age 65) at an outpatient Geriatric Day Hospital (GDH) with possible prescribing cascades (identified by a GDH team member), their caregivers, and healthcare providers. Data were analyzed using an inductive content analysis approach.ResultsFourteen participants were interviewed (eight patients, one family caregiver, one GDH pharmacist, three GDH physicians and one family physician) providing a total of 22 interviews about patient-specific cases. The complexity and contextually situated nature of prescribing cascades created challenges for all of those involved with their identification. Three themes impacted how prescribing cascades developed and persisted: varying awareness of medications and cascades; varying feelings of accountability for making decisions about medication-related care; and accessibility to an ideal environment and relevant information. Actions to prevent, identify or resolve cascades were suggested.ConclusionPatients and healthcare providers struggled to recognize prescribing cascades and identify when they had occurred; knowledge gaps contributed to this challenge and led to inaction. Strategies that equip patients and clinicians with resources to recognize prescribing cascades and environmental and social supports that would help with their identification are needed. Current conceptualizations of cascades warrant additional refinement by considering the nuances our work raises regarding their appropriateness and directionality.

【 授权许可】

CC BY