Saudi Cultural Missions Theses & Dissertations
Permanent URI for this communityhttps://drepo.sdl.edu.sa/handle/20.500.14154/10
Browse
2 results
Search Results
Item Restricted PHARMACISTS’ OPINIONS, PREFERENCES, AND ATTITUDES TOWARDS DEPRESCRIBING: A MIXED-METHODS STUDY(Nova Southeastern University, 2025-04-17) Alwadai, Ali; Sánchez, JesúsPolypharmacy, prevalent especially among older adults, affects approximately 10–20% of the general population and 40–60% of geriatric patients worldwide. Deprescribing, a systematic approach to discontinuing or reducing medications when risks outweigh benefits, involves pharmacists who play a crucial role in medication safety and improving quality of life. This study aimed to provide a valid, comprehensive tool in English to investigate pharmacists' opinions, preferences, and attitudes towards deprescribing, assessing pharmacists' knowledge, awareness, facilitators, and barriers related to deprescribing in Florida. It also qualitatively explores specific barriers and facilitators in various healthcare settings. This study utilized a sequential explanatory mixed-methods approach conducted in three phases: (1) translation, cultural adaptation, and psychometric validation of the CHOPPED questionnaire from Croatian into English, including assessments of internal consistency, test-retest reliability, and construct validity. (2) Quantitative assessment of pharmacists' knowledge, awareness, and perceived barriers and facilitators to deprescribing in Florida using the validated questionnaire. (3) Qualitative exploration through semi-structured interviews to identify and examine deeper insights into deprescribing barriers and facilitators across various healthcare settings. Cronbach’s alpha was 0.884, indicating good internal consistency, and Intraclass correlation coefficient values indicated moderate to excellent reliability. Factor analysis refined CHOPPED into seven factors by merging domains, deleting overlapping items, and transferring items between domains. Pharmacists demonstrated strong knowledge and awareness of deprescribing’s role in improving outcomes and reducing expenditures. Significant barriers included time constraints, unclear guidelines, and low physician acceptance of pharmacists' recommendations, particularly in community pharmacies. Facilitators identified were collaboration with physicians, comprehensive patient information availability, previous successful deprescribing iv experiences, and access to deprescribing-focused education and resources. The observed variations in pharmacists' perceptions of deprescribing, shaped by practice type, professional experience, and educational background, highlight the need for tailored interventions that address the specific challenges and requirements of different practice environments.16 0Item Restricted A Multimethod Approach To Identify Factors And Improve The Process Of Deprescribing Anticholinergics In Older Adults.(HammerRR, 2023-04-28) Alamer, Khalid Ahmed A; Campbell, NollPolypharmacy in older adults presents several challenges, such as suboptimal therapeutic outcomes and increased adverse effects. Deprescribing, a clinically supervised process of decreasing dosage or stopping the medication when risks outweigh benefits, has emerged as one possible solution to these problems. However, the literature describing deprescribing intervention frameworks is heterogenous regarding targeted medications to deprescribe, population characteristics, clinical settings, and measured outcomes. This dissertation utilizes Linsky et al.'s deprescribing conceptual model, which details factors influencing decisions regarding initiating deprescribing interventions and their direct impact on the process. This dissertation utilizes a multimethod approach to investigate factors that facilitate and improve the deprescribing of anticholinergic medications for older adults, addressing gaps in this population's anticholinergic medication use. The three studies included in this dissertation provide a comprehensive understanding of deprescribing anticholinergic medications for this population, each contributing unique insights and results. The first study explores the feasibility of in-person and remote Home Medication Inventory Method (HMIM) approaches to evaluate over-the-counter (OTC) and prescription medication possession and use, including anticholinergics. Results demonstrate that both methods can accurately assess anticholinergic medication usage patterns, providing healthcare providers with reproducible methods and detailed medication profiles to make informed deprescribing decisions based on complete medication lists. The second study examined the intertwined roles of social determinants of health and health beliefs in predicting older adults' self-reported deprescribing behaviors, proposing the Deprescribing Health Belief Model (DeRx-HBM) framework that can be utilized for these efforts. These results emphasize the importance of considering these elements when creating a patient-centric and culturally sensitive intervention since they significantly shape deprescribing behaviors. In the third study, we explored the use of a symptom-specific scale for measuring the symptom burden in older adults during the deprescribing of anticholinergic medications prescribed for urinary incontinence, depression, and pain management. This research introduces a validated scale for assessing anticholinergic symptom burden prior to, throughout, and following the deprescribing attempt. The implementation of this scale has the potential to enhance the reproducibility and standardization of deprescribing decisions. Furthermore, it can improve communication between healthcare professionals and patients, as well as monitor the effectiveness of interventions during and after the deprescribing process. Collectively, these studies provide invaluable insights into factors influencing deprescribing decisions, obstacles to implementing deprescribing practices, and potential strategies to optimize medication management in older adults. The major takeaway from these studies is that addressing these factors leads to more informed decisions among healthcare professionals and patients - potentially leading to improved patient outcomes, ensure the ongoing effectiveness of deprescribing initiatives among older adults, and the promotion of health equity throughout the deprescribing process.10 0