Evidence map›Paper›PMID 33240479›Full record

ArticleTherapeutic advances in drug safety2020

Prescribing cascades in persons with Alzheimer's disease: engaging patients, caregivers, and providers in a qualitative evaluation of print educational materials.

Sarah Bloomstone, Kathryn Anzuoni, Noelle Cocoros, Jerry H Gurwitz, Kevin Haynes, Vinit P Nair, Richard Platt, Paula A Rochon, Sonal Singh, Kathleen M Mazor

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Therapeutic advances in drug safety, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 1 pooled it
0.6field-weighted citation impact, top 34% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. Pooled it
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  10. The US Food and Drug Administration Sentinel System: a national resource for a learning health system.Journal of the American Medical Informatics Association : JAMIA · 2022
    Article
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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

10 authors at 5 institutions in 2 countries.

Sarah BloomstoneUniversity of Massachusetts Medical School, Worcester, MA, USA and Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, 385 Grove Street, Worcester, MA 01655-0112, USA.ORCID https://orcid.org/0000-0002-3022-6620
Kathryn AnzuoniUniversity of Massachusetts Medical School, Worcester, MA, USA and Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.
Noelle CocorosDepartment of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Jerry H GurwitzUniversity of Massachusetts Medical School, Worcester, MA, USA and Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.
Kevin HaynesHealthCore, Inc. Wilmington, DE, USA.
Vinit P NairHumana Inc., Louisville, KY, USA.
Richard PlattDepartment of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Paula A RochonWomen's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Sonal SinghUniversity of Massachusetts Medical School, Worcester, MA, USA and Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.ORCID https://orcid.org/0000-0003-0912-941X
Kathleen M MazorUniversity of Massachusetts Medical School, Worcester, MA, USA and Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.
University of Massachusetts Chan Medical School · USHarvard University · USHumana (United States) · USUniversity of Toronto · CAWilmington University · US

Funding

Controlling And Stopping Cascades leading to Adverse Drug Effects Study in Alzheimer's Disease (CASCADES-AD)R56AG061813 · NIA · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI GURWITZ, JERRY H · 2018 to 2018
$817k
NIA NIH HHS R56 AG061813
6 · The paper itself

Abstract

introductionPrescribing cascades occur when the side effect of a drug is misinterpreted as a new medical condition, and a second drug is prescribed to address the side effect. Persons with Alzheimer's disease (AD) are at increased risk of prescribing cascades due to greater multimorbidity, polypharmacy, and complexity of care. The objective of this study was to evaluate educational materials about prescribing cascades in persons with AD, and elicit input on their use in a future trial.

methodsWe interviewed community-dwelling adults with either an AD diagnosis or a prescription drug used to treat AD (

resultsAnalysis of patients', caregivers', and providers' comments suggest: (a) Providers had conflicting views about the messaging of materials; (b) Caregivers were likely to read letters addressed to patients; (c) Providers were likely to ignore letters, but were receptive to patient/caregiver-initiated conversations; (d) Patients and caregivers had difficulty understanding prescribing cascades; (e) Providers worried that mailed materials would undermine trust; (f) Participants had mixed views on how materials might affect the clinical encounter; (g) Participants felt that materials would improve patient/caregiver engagement. When surveyed, most providers found the revised materials informative and actionable, and most caregivers found them understandable and useful.

conclusionsThis evaluation of educational materials about prescribing cascades in patients with AD provides strong support for engaging caregivers to communicate with providers about prescribing cascades. By giving patients and caregivers a basic description of the prescribing cascade concept, our educational materials may help them prepare for a conversation with the provider, who can then tailor the discussion of the possible cascade to the specific needs of the individual patient and caregiver. However, evidence on whether materials can stimulate such conversations awaits testing in a future trial. LAY SUMMARY:

Indexed as

Alzheimer’s disease and related dementiasEducational materialsMedication safetyOlder adultsPrescribing cascades

Identifiers

PMID33240479
PMCPMC7675869
OpenAlexW3095340726

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.