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CDA 12-166 – HSR&D Study

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CDA 12-166
Patient and provider perceptions of intentional medication discontinuation
Amy M Linsky MD MSc
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: May 2014 - April 2019

BACKGROUND/RATIONALE:
Adverse outcomes from inappropriate medication use, whether measured as adverse clinical events, increased health care costs or decreased quality of life, are pervasive, even within the VA. Clinicians lack evidence and clinical guidelines to indicate best practices for evaluating patients' medication regimens to determine which drugs, if any, may safely be discontinued. While significant attention is given to medication reconciliation, there has been less focus on improving intentional discontinuation of medications ("deprescribing") that may no longer be necessary or whose benefits no longer outweigh associated risks. Prescribing decisions are predicated on accurate completion of medication reconciliation. The complexity of health care, even within an integrated system such as the VA, can introduce medication discrepancies, which are differences between what is documented and what the patient is actually taking. One type of discrepancy, therapeutic duplication, has the potential for unintentional overdose and may result from failure to deprescribe.

OBJECTIVE(S):
1) To identify and measure patient and provider beliefs and attitudes associated with medication discontinuation; 2) To determine the frequency and correlates of therapeutic duplications to identify potential intervention targets; and 3) To develop and pilot test an intervention to facilitate medication review with consideration of potential medication discontinuation.

METHODS:
We used survey methods, secondary database analyses, and intervention development and implementation. We developed, validated and administered two distinct surveys - one patient-oriented and one provider-oriented. We used administrative data to determine the prevalence of and factors associated with excess medication supply. Finally, we pilot tested a patient-centered intervention to promote patient-provider communication about deprescribing.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Impact - The research proposed here will facilitate the appropriate use of medications so as to ensure the efficient use of resources. This, in turn, can improve the quality of Veterans' health care by reducing the use of potentially unnecessary medications, leading in turn to reduced medication costs, fewer adverse drug events and drug-drug interactions, decreased health care spending and improved patient safety.

PUBLICATIONS:

Journal Articles

  1. Linsky A, Simon SR, Stolzmann K, Meterko M. Patient attitudes and experiences that predict medication discontinuation in the Veterans Health Administration. Journal of the American Pharmacists Association : JAPhA. 2018 Jan 1; 58(1):13-20.
  2. Linsky A, Meterko M, Stolzmann K, Simon SR. Supporting medication discontinuation: provider preferences for interventions to facilitate deprescribing. BMC health services research. 2017 Jun 28; 17(1):447.
  3. Patel CH, Zimmerman KM, Fonda JR, Linsky A. Medication Complexity, Medication Number, and Their Relationships to Medication Discrepancies. The Annals of pharmacotherapy. 2016 Jul 1; 50(7):534-40.
  4. Linsky A. Capsule Commentary on Genoff et al., Navigating Language Barriers: A Systematic Review of Patient Navigators' Impact on Cancer Screening for Limited English Proficient Patients. Journal of general internal medicine. 2016 Apr 1; 31(4):415.
  5. Linsky A, Simon SR. Patients' perceptions of their "most" and "least" important medications: a retrospective cohort study. BMC research notes. 2012 Nov 2; 5:619.
  6. Linsky A, Simon SR. Medication discrepancies in integrated electronic health records. BMJ quality & safety. 2013 Feb 1; 22(2):103-9.
  7. Linsky A, Hermos JA, Lawler EV, Rudolph JL. Proton pump inhibitor discontinuation in long-term care. Journal of the American Geriatrics Society. 2011 Sep 1; 59(9):1658-64.
VA Cyberseminars

  1. Linsky AM. Pharmacy Process to Reduce Medication Duplications. [Cyberseminar]. 2016 Oct 30.
  2. Linsky AM. Patient and Provider Perceptions of Medication Deprescribing. HSR&D Career Development Awardee Series [Cyberseminar]. HSR&D. 2016 May 24.
Conference Presentations

  1. Linsky AM, Simon SR, Stolzmann KL, Meterko MM. Patient Perceptions of Deprescribing (PPoD): Survey Development and Validation. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 14; Hollywood, FL.
  2. Patel CH, Zimmerman KM, Fonda JR, Linsky AM. Medication Complexity, Medication Number, and Their Relationships to Medication Discrepancies. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 13; Hollywood, FL.


DRA: Health Systems
DRE: Prevention, Technology Development and Assessment, Treatment - Preclinical
Keywords: Career Development
MeSH Terms: none