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Table 3 Preferences for Interventions to Improve Ability to Deprescribe Medications

From: Supporting medication discontinuation: provider preferences for interventions to facilitate deprescribing

  First Choice Second Choice Third Choice
All Respondents
 All (326) Indication for use Assistance with follow-up Patient involvement
Age
 <49 years (118) Indication for use Assistance with follow-up Information exchange with all pharmacies
 50–59 years (120) Indication for use Assistance with follow-up Patient involvement
 ≥60 years (83) Indication for use Patient involvement Assistance with follow-up
Gender
 Male (151) Indication for use Assistance with follow-up Patient involvement
 Female (165) Assistance with follow-up Indication for use Patient involvement
Race
 White (235) Assistance with follow-up Indication for use Patient involvement
 Non-White (81) Indication for use Patient involvement Clinical decision support
Provider type
 Physician (243) Indication for use Assistance with follow-up Patient involvement
 Nurse Practitioner or Physician Assistant (53) Indication for use Assistance with follow-up Patient involvement
 Clinical Pharmacy Specialist (30) Indication for use Information exchange with all pharmacies Improved information exchange with providers located at community facilities
Number of clinic sessions per week
 ≤7 (148) Assistance with follow-up Indication for use Patient involvement
 8–10 (167) Indication for use Patient involvement Assistance with follow-up
Number of years working in VA
 ≤4 (94) Indication for use Information exchange with all pharmacies Assistance with follow-up
 5–9 (80) Assistance with follow-up Indication for use Patient involvement
 ≥10 (146) Indication for use Assistance with follow-up Patient involvement
Prior experience working in a non-VA setting
 Yes (250) Indication for use Assistance with follow-up Patient involvement
 No (69) Assistance with follow-up Patient involvement Indication for use
Self-rated comfort with medication discontinuation (0–10 scale)
 Low, 0–6 (83) Assistance with follow-up Indication for use Information exchange with all pharmacies
 Medium, 7–8 (126) Assistance with follow-up Indication for use Patient involvement
 High 9–10 (108) Indication for use Assistance with follow-up Information exchange with all pharmacies
Beliefs about medication overuse
 Neutral/disagree/strongly disagree (288) Indication for use Assistance with follow-up Patient involvement
 Agree/strongly agree (38) Patient involvement Indication for use Information exchange with all pharmacies
Perceptions of patients’ ability to manage their own health
 Less (223) Indication for use Assistance with follow-up Patient involvement
 More (101) Indication for use Patient involvement Assistance with follow-up
Frequency of experiencing uncertainty about the indication for a patient’s medication
 Never/Rarely (83) Indication for use Assistance with follow-up Information exchange with all pharmacies
 Sometimes (173) Assistance with follow-up Indication for use Patient involvement
 Often/Usually (68) Indication for use Patient involvement Assistance with follow-up
Experience with discontinuing medications initiated by other providers
 Never/rarely (46) Patient involvement Indication for use Clinical decision support
 Sometimes (271) Indication for use Assistance with follow-up Patient involvement
 Often/usually (8) Assistance with follow-up Indication for use Patient involvement
Experience with patient activation
 Low (117) Indication for use Assistance with follow-up Information exchange with all pharmacies
 Medium (108) Assistance with follow-up Indication for use Patient involvement
 High (97) Patient involvement Indication for use Assistance with follow-up
  1. Indication for use = Requiring all medication prescriptions to have an associated “indication for use”
  2. Assistance with follow-up = Assistance with follow-up of patients as they taper of discontinue medications is performed by another member of the Patient Aligned Care Team (PACT)
  3. Patient involvement = Increased Patient involvement in prescribing decisions
  4. Information exchange with all pharmacies = Improved information exchange with all VA and non-VA pharmacies to confirm medication reconciliation
  5. Clinical decision support = Use of clinical decision support tools, such as drug-drug alerts, within the electronic health record