Background

There are many barriers to deprescribing in the routine care of older inpatients with polypharmacy. Implementation is limited by factors related to clinicians, patients, and the acute care setting. A short (11 min) e-learning module for multidisciplinary hospital clinicians was developed to address two commonly reported barriers: awareness of polypharmacy and self-efficacy in deprescribing.

Objectives

1) Describe the level of awareness of polypharmacy and self-efficacy of deprescribing in multi-disciplinary hospital clinicians following completion of an online e-learning module; and 2) describe the immediate impact of an online educational module in awareness and self-efficacy of polypharmacy and deprescribing in senior medical students.

Methods

A questionnaire was developed and administered to hospital clinicians following completion of the e-learning module. Senior medical students undertook the questionnaire pre- and post-module.

Results

Overall, 99 hospital clinicians with diverse clinical roles, experience, and ages, and 30 medical students completed the questionnaire. Although most (≥80%) hospital clinicians reported a general awareness of polypharmacy and deprescribing, there was moderate to low current activity in medication review and deprescribing, a perceived lack of role in medication review by junior doctors, and minimal knowledge of deprescribing tools. Use of a previously validated self-efficacy questionnaire showed lowest self-efficacy in domains related to developing deprescribing plans and implementing them. Pre-post analysis of medical student responses found a small statistically significant improvement following viewing the module in awareness of polypharmacy, deprescribing and deprescribing tools, perception of their role in deprescribing, and self-efficacy in planning and implementation of deprescribing decisions.

Conclusions

Hospital clinicians and senior medical students had limited self-efficacy in deprescribing and hospital clinicians reported they did not deprescribe frequently. Targets for educational and behavioral interventions were identified. A short e-learning module on polypharmacy and deprescribing may be a useful component of a multi-strategic intervention to implement deprescribing into routine inpatient care.

中文翻译：

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多学科医院临床医生在查看电子学习模块前后以及医学生之前和之后报告的对处方的看法和实践

背景

在对老年住院患者进行多种药物治疗的常规护理中，取消处方存在许多障碍。实施受到与临床医生、患者和急性护理环境相关的因素的限制。为多学科医院临床医生开发了一个简短（11 分钟）的电子学习模块，以解决两个普遍报告的障碍：对多种药物的认识和处方中的自我效能。

目标

1) 描述完成在线学习模块后，多学科医院临床医生对多药治疗的认识水平和开药的自我效能；2) 描述在线教育模块对高年级医学生的多药治疗和开药的意识和自我效能的直接影响。

方法

完成电子学习模块后，我们制定了一份问卷并发给医院临床医生。高级医学生在模块前和模块后进行了问卷调查。

结果

总体而言，99 名具有不同临床角色、经验和年龄的医院临床医生和 30 名医学生完成了问卷。尽管大多数 (≥80%) 医院临床医生报告了对多种药物和开药方的普遍认识，但目前在药物审查和开药方方面的活动中度至低，初级医生认为缺乏药物审查的作用，并且对开药方工具的了解很少。使用先前经过验证的自我效能调查表显示，在与制定和实施减药计划相关的领域中，自我效能最低。对医学生反应的事前分析发现，在查看该模块后，在对多种药物的认识、开药和开药工具、对其在开药中的作用的认识、

结论

医院临床医生和高级医学生在开药方面的自我效能有限，医院临床医生报告说他们不经常开药。确定了教育和行为干预的目标。关于多药治疗和取消处方的简短电子学习模块可能是将取消处方纳入常规住院护理的多战略干预的有用组成部分。