La prise de décision partagée en consultation pharmaceutique : Développement, conduite et évaluation d’une intervention à l’hôpital de jour gériatrique des Cliniques universitaires Saint-Luc

Details

Supervisors

Dalleur, Olivia ; Vaillant, Fanny

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

BACKGROUND. As older patients often face health decisions and have diverse preferences, shared decision-making (SDM) is relevant. SDM is a patient-centered approach promoting collaboration between patients and healthcare professionals in making informed and preference-based decisions and is recognized as a key element in healthcare quality. Yet, SDM can be difficult to put into practice, but the use of decision aids (DAs) and other resources can facilitate this process. OBJECTIVE. To develop, conduct and evaluate a SDM intervention using DAs during clinical pharmacist-led consultations with older patients attending a geriatric day hospital. METHOD. The approach followed was inspired by the five steps proposed by the Ottawa Hospital Research Institute for implementing DAs : (1) identify decision from frequently encountered STOPP/START criteria, (2) find or develop DAs, (3) identify barriers and explore ways to overcome them, (4) implement and provide training, and (5) monitor use and outcomes. As part of the second step, a DA was developed according to the International Patient Decision Aid Standards (IPDAS). The process included creating a DA prototype through literature research, assessing its acceptability (alpha testing) among 5 patient partners, 7 pharmacists and 2 physicians, producing a final version integrating feedback and conducting field testing (beta testing) with 2 patients. Finally, the SDM process was evaluated from the point of view of both patients and pharmacists conducting the intervention, using the SDM-Q-9 and SDM-Q-Doc tools. RESULTS. The SDM intervention was proposed on three topics : vitamin D supplementation for falls, proton pump inhibitors deprescribing, and benzodiazepines (BZD) and z-drugs in insomnia deprescribing. Existing DAs for the first two topics have been found in the literature and the third one was developed. The alpha testing results of the DA prototype were favorable and led to a final DA on insomnia in older patients considering discontinuation of BZD and z-drugs. Regarding the SDM process evaluation, both pharmacists and patients had a good perception of SDM during consultations. CONCLUSION. We developed, conducted and evaluated a SDM intervention using DAs, including the systematic development of a DA on deprescribing BZD and z-drugs in insomnia among older patients, which was deemed acceptable for stakeholders.