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      Reduction of inappropriate prescriptions in older adults through the support of Asynchronous Geriatric Counseling Online (AGAlink): Implemented in primary care

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          Abstract

          Background/Aim

          Medication prescription is a fundamental component in the care of the elderly. Several characteristics of aging and geriatric medicine affect prescriptions for these people and make the selection of drug therapy a difficult and complex process. The objective of this study is to develop a geriatric portal for asynchronous online counseling (AGAlink) for use by physicians specializing in family medicine to reduce medication problems among older adult patients in the first level of care.

          Method

          A qualitative study was carried out in the first level of care at the Mexican Institute of Social Security (IMSS), 31 family doctors were interviewed to identify attitudes, preferences about the use of the AGAlink geriatric portal, as well as their recommendations for the implementation of this tool in their daily practice. For the analysis of the data obtained, a qualitative thematic content analysis was used.

          Results

          90% of the physicians used the geriatric portal outside office hours without the need for the patient to be present. The perception of the physician towards the use of the AGAlink geriatric portal was favorable, provided relevant information and had several positive effects on the process of care for medical prescription. The barriers identified to accept the change in medication were not having the proposed therapeutic option, lack of any laboratory analysis, continuing to consider their experience for the prescription of the medication.

          Conclusions

          The AGAlink geriatric portal was a tool that was well received by physicians who expressed a positive attitude, considered an investment of a short time that allowed them to update and learn about strategies to reduce the prescription problems presented among the elderly population. However, the main barrier was the use of technology, especially in the doctors with more seniority in the service.

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          Most cited references26

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          A Tong, P SAINSBURY, J. Craig (2007)
          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Sample Size in Qualitative Interview Studies: Guided by Information Power

            Volkert Dirk Siersma, Ann Guassora, Kirsti Malterud (2015)
            Sample sizes must be ascertained in qualitative studies like in quantitative studies but not by the same means. The prevailing concept for sample size in qualitative studies is "saturation." Saturation is closely tied to a specific methodology, and the term is inconsistently applied. We propose the concept "information power" to guide adequate sample size for qualitative studies. Information power indicates that the more information the sample holds, relevant for the actual study, the lower amount of participants is needed. We suggest that the size of a sample with sufficient information power depends on (a) the aim of the study, (b) sample specificity, (c) use of established theory, (d) quality of dialogue, and (e) analysis strategy. We present a model where these elements of information and their relevant dimensions are related to information power. Application of this model in the planning and during data collection of a qualitative study is discussed.
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              American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

              (2019)
              The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3-year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674-694, 2019.
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                Author and article information

                Contributors
                Annia Marisol Avalos-Mejia: Role: Data curationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draft
                Juan Carlos García-Cruz: Role: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Jorge Escobedo de la Peña: Role: Formal analysisRole: MethodologyRole: ValidationRole: Writing – review & editing
                Osvaldo Garrido-Acosta: Role: MethodologyRole: SoftwareRole: Supervision
                Teresa Juárez-Cedillo:
                ORCID: https://orcid.org/0000-0002-9442-3471
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Vijayaprakash Suppiah: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 17 November 2021
                Publication date Collection: 2021
                Volume: 16
                Issue: 11
                Electronic Location Identifier: e0258414
                Affiliations
                [1 ] Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social (Actualmente comisionada en la Unidad de Investigación en Epidemiológica Clínica, Hospital General Regional Núm. 1 Dr. Carlos Mac Gregor Sánchez Navarro, IMSS), Ciudad de México, México
                [2 ] División de Medicina Geriátrica, Departamento de Medicina., Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
                [3 ] Unidad de Investigación en Epidemiológica Clínica, Hospital General Regional Núm. 1 Dr. Carlos Mac Gregor Sánchez Navarro, IMSS, Ciudad de México, México
                [4 ] Facultad de Estudios Superiores Zaragoza, UNAM, Estado de México, México
                University of South Australia, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-9442-3471
                Article
                Publisher ID: PONE-D-20-29670
                DOI: 10.1371/journal.pone.0258414
                PMC ID: 8598027
                PubMed ID: 34788287
                SO-VID: cdf8b4e3-5aaa-4cfd-a063-4689cc8467de
                Copyright © © 2021 Avalos-Mejia et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 20 September 2020
                Date accepted : 27 September 2021
                Page count
                Figures: 3, Tables: 2, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100005343, Fundación IMSS;
                Award ID: FIS / IMSS /PROT/G11/938
                Award Recipient :
                ORCID: https://orcid.org/0000-0002-9442-3471
                This project was supported by donations from the Fund for the Promotion of Research in Health, Mexican Institute of Social Security, FIS / IMSS /PROT/G11/938. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Providers
                Subject: Physicians
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Medical Personnel
                Subject: Physicians
                Subject: Medicine and Health Sciences
                Subject: Geriatrics
                Subject: Computer and Information Sciences
                Subject: Computer Networks
                Subject: Internet
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Geriatric Care
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Adults
                Subject: Elderly
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Primary Care
                Subject: Medicine and Health Sciences
                Subject: Pharmaceutics
                Subject: Drug Therapy
                Subject: Medicine and Health Sciences
                Subject: Pharmacology
                Subject: Drug Research and Development
                Custom metadata
                Data Availability The are ethics restrictions on sharing data set because data contain potentially identifying and sensitive of the treating physician and patient information. Data are available from the Instituto Mexicano del Seguro Social Institutional Data Access / Ethics Committee (contact via e-mail comision.etica@ 123456imss.gob.mx or the phone 56276900 ext. 21230) for researchers who meet the criteria for access to confidential data.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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