A qualitative interview study to explore the need for a prescribing tool specific to people living with dementia

Abstract Introduction The literature reports that people living with dementia (PLWD) are more frequently impacted by medication-related issues such as potentially inappropriate prescribing compared to older people without dementia.[1] Only a small number of prescribing tools (e.g. MATCH-D[2]) have been developed to guide prescribing and medication management for PLWD with development often taking a region-specific approach. Aim To explore the perspectives of researchers who have published work on medication use in older people and PLWD, regarding the need for a prescribing tool specific to PLWD. Methods Participants were purposively sampled through online searches of relevant published literature and personal contacts of the research team, with additional recruitment via snowballing. It was anticipated a priori that 10–15 interviews would be required to reach data saturation. Semi-structured interviews were conducted via Microsoft Teams, using a pre-prepared, piloted topic guide. Questions related to the suitability of current prescribing tools for PLWD, the need for a dementia-specific tool, and its content, should it be developed in the future. Interviews were audio-recorded and transcribed verbatim. Transcripts were independently coded by two researchers and analysed using inductive thematic analysis. Results Ten interviews were conducted, lasting between 14–29 minutes. Participants had varied backgrounds as pharmacists (n = 5), physicians (n = 4) and one with no clinical experience. Participants were based in Australasia (n = 4), Europe (n = 4) and North America (n = 2). Thematic analysis generated four themes. Within the first theme, ‘participant perspectives of using prescribing tools,’ participants described being familiar with a range of prescribing tools in both their research and clinical work, with many detailing their involvement in developing tools. The second theme, ‘existing prescribing tools: pros and cons,’ highlighted that tools could be useful for clinicians by identifying areas of focus, yet often lacked context of prescribing decisions and could be challenging to apply in a clinical setting: “[A prescribing tool] declares potentially inappropriate use of medications. It doesn’t flag actual inappropriate use of medications… ‘cause you don’t really have the full story” [R10]. The third theme, ‘unique medicines management challenges for PLWD,’ described how issues such as communication barriers and challenging decision-making made prescribing for PLWD more complex. Within the final theme, ‘making the case for a dementia-specific prescribing tool,’ most participants felt such a tool would be beneficial, as currently available tools only had limited usefulness for PLWD: “There’s no reason why these tools can’t be used for people with dementia, but they’re not specific for people with dementia” [R03]. Participants had mixed views about whether the tool should contain explicit or implicit criteria and recommended a range of areas of focus for a new tool, ranging from specific medications to palliative care guidance. Conclusion This study has identified the need for a dementia-specific prescribing tool, using robust methodology. However, as most participants were from similar geographical areas, study findings may not be generalisable to other regions. Further research will aim to reach consensus on the recommended content for this new tool should it be developed in the future, with an expert panel of researchers and clinicians.