PMID- 31322134
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1929-0748 (Print)
IS  - 1929-0748 (Electronic)
IS  - 1929-0748 (Linking)
VI  - 8
IP  - 7
DP  - 2019 Jul 18
TI  - Using a Triple Aim Approach to Implement "Less-is-More Together" and Smarter 
      Medicine Strategies in an Interprofessional Outpatient Setting: Protocol for an 
      Observational Study.
PG  - e13896
LID - 10.2196/13896 [doi]
LID - e13896
AB  - BACKGROUND: Increased awareness of the world's problematic growing health care 
      expenditure and health care shortages requires sustainable use of available 
      resources. To promote cultural changes in medical mindsets, societies 
      representing medical specialties have developed new Choosing Wisely strategies. 
      The Valais Medical Society and the Valais Pharmacy Association have developed an 
      interprofessional collaboration project entitled "Less-is-more Together-PPI" to 
      analyze and optimize change management practices focusing on the prescription and 
      deprescription of proton pump inhibitors (PPIs). OBJECTIVE: This study aims to 
      enhance interprofessional collaboration between physicians, pharmacists, and 
      patients to optimize PPI use, avoid unnecessary treatments and improve 
      therapeutic adherence to indicated therapies, and to analyze hindrances and 
      facilitators to implementing interprofessional Less-is-more strategies in the 
      field. METHODS: Home-dwelling adults domiciled in Valais and prescribed PPIs in 
      the last 6 months will be invited to participate in this observational study. The 
      studied subpopulation will be constituted of consenting patients whose physicians 
      and pharmacists also voluntarily agree to participate. The process of collecting, 
      pooling, transmitting, evaluating, and protecting data has been validated by the 
      Human Research Ethics Committee of the Canton Vaud. RESULTS: The Primary Triple 
      Aim outcome measures will be (1) population health: patient's assessment of their 
      own health, functional status, and disease burden using a monthly questionnaire 
      for 6 months; Behavioral/physiological factors will be investigated using a final 
      questionnaire at 6 months, (2) experience of care: assessment using a final 
      questionnaire for participating patients, pharmacists and physicians, and an 
      analysis of negative/positive experiences via 6 follow-up questionnaires, and (3) 
      Per capita cost: participants' fluctuating or decreasing PPI intake (number of 
      pills/dosage) and an analysis of participants' different categories following 
      their medical prescription, in relation to possible bias effects on the overall 
      drug intake of the population studied. Secondary outcomes will be participation 
      rates; patient, physician, and pharmacist follow-up; and evaluations of 
      participants' experiences and their perceived benefits, as well as whether the 
      interprofessional process can be improved. CONCLUSIONS: This project seeks a 
      deeper understanding of how Less-is-more and smarter-medicine strategies are 
      perceived by patients and health care providers in their daily lives in a very 
      specific context. It will reveal some of the hindrances to and facilitators for 
      efficient cultural change toward a more sustainable health care system. The 
      results will be useful to optimize and scale up further Choosing Wisely 
      approaches. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): 
      DERR1-10.2196/13896.
CI  - (c)Monique Lehky Hagen, Rene Julen, Pierre-Alain Buchs, Anne-Laure Kaufmann, 
      Jean-Michel Gaspoz, Henk Verloo. Originally published in JMIR Research Protocols 
      (http://www.researchprotocols.org), 18.07.2019.
FAU - Lehky Hagen, Monique
AU  - Lehky Hagen M
AUID- ORCID: 0000-0002-2734-7448
AD  - Valais Medical Society, Sion, Switzerland.
FAU - Julen, Rene
AU  - Julen R
AUID- ORCID: 0000-0002-9678-3307
AD  - Pharmavalais, Brig-Glis, Switzerland.
FAU - Buchs, Pierre-Alain
AU  - Buchs PA
AUID- ORCID: 0000-0002-9405-5613
AD  - Pharmavalais, Sion, Switzerland.
FAU - Kaufmann, Anne-Laure
AU  - Kaufmann AL
AUID- ORCID: 0000-0003-3282-1404
AD  - Institute of Health, HES-SO Valais-Wallis, University of Applied Sciences and 
      Arts Western Switzerland, Sierre, Switzerland.
FAU - Gaspoz, Jean-Michel
AU  - Gaspoz JM
AUID- ORCID: 0000-0001-7574-1290
AD  - Clinique des Grangettes, Chene-Bougeries, Switzerland.
AD  - Health & Community Medicine, Faculty of Medicine, School of Medicine, University 
      of Geneva, Geneva, Switzerland.
FAU - Verloo, Henk
AU  - Verloo H
AUID- ORCID: 0000-0002-5375-3255
AD  - School of Health Sciences, University of Applied Sciences and Arts Western 
      Switzerland Valais (HES-SO Valais-Wallis), Sion, Switzerland.
AD  - Service of Old Age Psychiatry, University Hospital Lausanne, Prilly, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20190718
PL  - Canada
TA  - JMIR Res Protoc
JT  - JMIR research protocols
JID - 101599504
PMC - PMC6670276
OTO - NOTNLM
OT  - deprescription
OT  - evidence-based medicine
OT  - family physicians
OT  - pharmacists
OT  - polypharmacy
OT  - prescription
COIS- Conflicts of Interest: None declared.
EDAT- 2019/07/20 06:00
MHDA- 2019/07/20 06:01
PMCR- 2019/07/18
CRDT- 2019/07/20 06:00
PHST- 2019/03/04 00:00 [received]
PHST- 2019/05/31 00:00 [accepted]
PHST- 2019/05/31 00:00 [revised]
PHST- 2019/07/20 06:00 [entrez]
PHST- 2019/07/20 06:00 [pubmed]
PHST- 2019/07/20 06:01 [medline]
PHST- 2019/07/18 00:00 [pmc-release]
AID - v8i7e13896 [pii]
AID - 10.2196/13896 [doi]
PST - epublish
SO  - JMIR Res Protoc. 2019 Jul 18;8(7):e13896. doi: 10.2196/13896.