Evidence map›Paper›PMID 31068402›Full record

ArticleJournal of the American Board of Family Medicine : JABFM

Clinicians' Perspectives on Barriers and Enablers of Optimal Prescribing in Patients with Dementia and Coexisting Conditions.

Ariel R Green, Patricia Lee, Emily Reeve, Jennifer L Wolff, Chi Chiung Grace Chen, Rachel Kruzan, Cynthia M Boyd

Registry-linked trialOpen access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Board of Family Medicine : JABFM. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06335953 (Demonstration of ALIGN), which is not on this map. Cited by 33 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 2 pooled it
2.3field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06335953 nacompletednot on this map

Demonstration of ALIGN: Aligning Medications With What Matters Most

TypeinterventionalSponsorJohns Hopkins UniversityRan2024 to 2025Enrolled474ConditionsPolypharmacy, Alzheimer's Disease and Related Dementias, Mild Cognitive ImpairmentArmsPharmacist-led deprescribing intervention
3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 49 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Article
  6. Article
  7. Article
  8. Nurse Practitioners' Experiences Navigating Treatment Decision-Making Affecting Older People with Neurocognitive Disorders and Cancer.The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres · 2026
    Article
  9. Article
  10. Observational
  11. Multimorbidity in dementia: Current perspectives and future challenges.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025
    Review
  12. Article
  13. Review
  14. Article
  15. Article
  16. Article
  17. Healthcare professionals' experiences with the use of antipsychotics in dementia.Exploratory research in clinical and social pharmacy · 2024
    Article
  18. Carers' experiences and perspectives of the use of anticholinergic medications in people living with dementia: Analysis of an online discussion forum.Health expectations : an international journal of public participation in health care and health policy · 2024
    Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 2 countries.

Ariel R GreenFrom Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB). ariel@jhmi.edu.
Patricia LeeFrom Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
Emily ReeveFrom Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
Jennifer L WolffFrom Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
Chi Chiung Grace ChenFrom Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
Rachel KruzanFrom Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
Cynthia M BoydFrom Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
Illinois College · USJohns Hopkins Medicine · USJohns Hopkins University · USUniversity of Illinois Chicago · US

Funding

Summer Research Training in Aging for Medical StudentsT35AG026758 · NIA · JOHNS HOPKINS UNIVERSITY · PI Stephanie Nothelle, Sevil Yasar · 2005 to 2026
$1.9M
Patient-Centered Care for Older Adults with Multiple Chronic Conditions: Research and Mentoring ProgramK24AG056578 · NIA · JOHNS HOPKINS UNIVERSITY · PI BOYD, CYNTHIA MELINDA · 2017 to 2021
$1.1M
Bladder Antimuscarinics in Dementia: A Model of Decisions About Potentially Inappropriate MedicinesK23AG054742 · NIA · JOHNS HOPKINS UNIVERSITY · PI GREEN, ARIEL · 2017 to 2020
$795k
NIA NIH HHS K23 AG054742NIA NIH HHS K24 AG056578NIA NIH HHS T35 AG026758
6 · The paper itself

Abstract

purposePatients with dementia experience high rates of polypharmacy, potentially inappropriate medication use, and adverse drug events. There is little guidance for clinicians on how to optimize prescribing for this population. Our objective was to investigate clinician-perceived barriers to and facilitators of optimizing prescribing for people with dementia.

methodsQualitative study involving semistructured interviews of primary care and specialist clinicians in urban, suburban, and rural settings. Transcripts were analyzed using qualitative content analysis.

resultsInterviews were conducted with 12 primary care and 9 specialist clinicians, with a mean (SD) age of 47 (9) and mean (SD) of 14 (10) years in practice. Clinicians cited decisions regarding the following drug classes as particularly challenging: oral anticoagulants, antidiabetic agents, statins, bladder antimuscarinics, and antipsychotics. Perceived enablers of optimizing prescribing included access to interdisciplinary services and guidelines for nondementia illnesses (eg, diabetes) addressing the care of people with dementia. Barriers included the lack of data on efficacy and safety of most medications in people with dementia, difficulty assessing medication effects in an individual patient, and the perception that stopping medications is seen as "giving up." Clinicians used a variety of strategies to discuss risks and benefits of medications with patients and caregivers.

conclusionsClinicians identified numerous barriers to and some facilitators of optimizing prescribing in people with dementia. More data are needed on the benefits and harms of stopping medications in this population. Research should also test different approaches for supporting informed decision making about medications by people with dementia and caregivers.

Indexed as

Clinical Decision-MakingPolypharmacyAdultCaregiversDementiaDrug PrescriptionsFemaleHumansInappropriate PrescribingMaleMiddle AgedMultimorbidityNurse PractitionersPhysicians, Primary CarePrimary Health CareQualitative ResearchAdverse Decision MakingComorbidityDementiaDrug ReactionGeriatricsPolypharmacyPotentially Inappropriate MedicationsPrimary Health CareQualitative ResearchRisk Assessment

Identifiers

PMID31068402
PMCPMC7043137
OpenAlexW2944395757

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.