# data[].attributes.headline
Accurately identifying the current efficacy of that particular medication in combination with the other medications to allow deprescribing.

# data[].attributes.subject
Accurately identifying the current efficacy of that particular medication in combination with the other medications to allow deprescribing.

# data[].attributes.body
If I did not prescribe the medication , then reaching out to prrescribing provider to discuss concerns can be a prolonged process and somewhat of a barrier

# data[].attributes.headline
concern that we won't be able to tell if 'worsening' is due to withdrawal of the medication vs typical fluctuation/progression of disease process. 

# data[].attributes.subject
concern that we won't be able to tell if 'worsening' is due to withdrawal of the medication vs typical fluctuation/progression of disease process. 

# data[].attributes.headline
Contacting the specialist or specialists who may have input regarding that medication

# data[].attributes.subject
Contacting the specialist or specialists who may have input regarding that medication

# data[].attributes.headline
Not always being sure that I am aware of all of the medications that a child is on

# data[].attributes.subject
Not always being sure that I am aware of all of the medications that a child is on

# data[].attributes.headline
by in from provider, family, and patient

# data[].attributes.subject
by in from provider, family, and patient

# data[].attributes.headline
if possible, have a central prescriber (PCP or palliative)

# data[].attributes.subject
if possible, have a central prescriber (PCP or palliative)

# data[].attributes.headline
you may not be the provider who is following up with the patient to identify effects of desprescribing

# data[].attributes.subject
you may not be the provider who is following up with the patient to identify effects of desprescribing

# data[].attributes.body
Testing may be needed

# data[].attributes.headline
Their child's health is always tenious and deprescribing usually occurs when the child is at their baseline.  Don't rock the boat.

# data[].attributes.subject
Their child's health is always tenious and deprescribing usually occurs when the child is at their baseline.  Don't rock the boat.

# data[].attributes.headline
they have multiple medical problems and/or previous medications have not achieved intended goals

# data[].attributes.subject
they have multiple medical problems and/or previous medications have not achieved intended goals

# data[].attributes.headline
Contact/ input from all providers who may have input regarding that medication

# data[].attributes.subject
Contact/ input from all providers who may have input regarding that medication

# data[].attributes.headline
Fear that the targeted symptom or issue may worsen as the medication is decreased or discontinued

# data[].attributes.subject
Fear that the targeted symptom or issue may worsen as the medication is decreased or discontinued

# data[].attributes.headline
patients can have multiple providers with input regarding various prescriptions

# data[].attributes.subject
patients can have multiple providers with input regarding various prescriptions

# data[].attributes.headline
having to schedule life around medications as opposed to medications helping to enhance living.

# data[].attributes.subject
having to schedule life around medications as opposed to medications helping to enhance living.

# data[].attributes.headline
every symptom or side effect is addressed with another medication (or so it seems)

# data[].attributes.subject
every symptom or side effect is addressed with another medication (or so it seems)

# data[].attributes.headline
you never really know if the medication is really not working or just not working well enough

# data[].attributes.subject
you never really know if the medication is really not working or just not working well enough

# data[].attributes.headline
All providers with organ systems or symptoms that may be impacted by deprescribing.

# data[].attributes.subject
All providers with organ systems or symptoms that may be impacted by deprescribing.

# data[].attributes.body
Needing prior auths and that can lead to delay in medication refills.

# data[].attributes.headline
things are going well/may get even worse if I take something off.

# data[].attributes.subject
things are going well/may get even worse if I take something off.

# data[].attributes.headline
understanding all potential  interactions between medications

# data[].attributes.subject
understanding all potential  interactions between medications

# data[].attributes.headline
they don't want symptoms to flare or conditions to get worse.  They don't want to harm the patient

# data[].attributes.subject
they don't want symptoms to flare or conditions to get worse.  They don't want to harm the patient

# data[].attributes.headline
Tracking the primary subspecialist responsible for prescribing a medication, even when it is overwritten by a resident during an acute hospitalization.

# data[].attributes.subject
Tracking the primary subspecialist responsible for prescribing a medication, even when it is overwritten by a resident during an acute hospitalization.

# data[].attributes.headline
distinguishing which side effects are attributed to each medication 

# data[].attributes.subject
distinguishing which side effects are attributed to each medication 

# data[].attributes.headline
worsening symptoms leading to hospitalization

# data[].attributes.subject
worsening symptoms leading to hospitalization

# data[].attributes.body
Dealing with multiple pharmacies for specialty meds.

# data[].attributes.headline
increased risk of interactions and potentially needing frequent monitoring

# data[].attributes.subject
increased risk of interactions and potentially needing frequent monitoring

# data[].attributes.headline
a single provider that has regular check-ins with the patient ultimately driving the taper

# data[].attributes.subject
a single provider that has regular check-ins with the patient ultimately driving the taper

# data[].attributes.headline
Find a mechanism for contacting all providers involved in the child's care.  Most providers/ specialties are responsive to PPL or e-mail.

# data[].attributes.subject
Find a mechanism for contacting all providers involved in the child's care.  Most providers/ specialties are responsive to PPL or e-mail.

# data[].attributes.headline
honest and openly.  Let me know before changes are made

# data[].attributes.subject
honest and openly.  Let me know before changes are made

# data[].attributes.headline
they want to keep medications as is if the patient is stable

# data[].attributes.subject
they want to keep medications as is if the patient is stable

# data[].attributes.body
Withdrawal side effects. Being able to restart medication in a timely manner if needed. Getting insurance to agree to pay for medication again if there were challenges initially getting the medication approved.

# data[].attributes.headline
Unrecognized pain or discomfort in a nonverbal patient.

# data[].attributes.subject
Unrecognized pain or discomfort in a nonverbal patient.

# data[].attributes.headline
parents dont have "extra tools" to manage flareups, etc--better to leave some meds PRN

# data[].attributes.subject
parents dont have "extra tools" to manage flareups, etc--better to leave some meds PRN

# data[].attributes.headline
we always want patients and families to have a better QOL.  We want less symptoms

# data[].attributes.subject
we always want patients and families to have a better QOL.  We want less symptoms

# data[].attributes.body
Condition may worsen.

# data[].attributes.headline
Another source of potential harm in a child already at risk for complications from their underlying diagnosis.

# data[].attributes.subject
Another source of potential harm in a child already at risk for complications from their underlying diagnosis.

# data[].attributes.headline
always trying to figure out which one is helping/hurting at this time

# data[].attributes.subject
always trying to figure out which one is helping/hurting at this time

# data[].attributes.headline
Most have multiple specialists and may not have a provider willing to be a "quarterback"

# data[].attributes.subject
Most have multiple specialists and may not have a provider willing to be a "quarterback"

# data[].attributes.body
Meds have to be spaced and given many times a day.

# data[].attributes.headline
there are too many services all writing their own medication rx involved in the management of medically complex children.

# data[].attributes.subject
there are too many services all writing their own medication rx involved in the management of medically complex children.

# data[].attributes.headline
E-mail or phone call, but be sure that I have communicated back and don't assume that I am simply ignoring you

# data[].attributes.subject
E-mail or phone call, but be sure that I have communicated back and don't assume that I am simply ignoring you

# data[].attributes.headline
risk of symptom rebound leading to morbidity 

# data[].attributes.subject
risk of symptom rebound leading to morbidity 

# data[].attributes.headline
Automatic refills, multiple subspecialties with various and sometimes juxtaposed goals

# data[].attributes.subject
Automatic refills, multiple subspecialties with various and sometimes juxtaposed goals

# data[].attributes.headline
I honestly can't think of one.  I believe that less is more.

# data[].attributes.subject
I honestly can't think of one.  I believe that less is more.

# data[].attributes.headline
any form of communication would be better than no communication!

# data[].attributes.subject
any form of communication would be better than no communication!

# data[].attributes.headline
you take away something that was actually making a difference leading to an adverse outcome.

# data[].attributes.subject
you take away something that was actually making a difference leading to an adverse outcome.

# data[].attributes.headline
Sometimes it is impossible to know how the child will respond because either the meds don't work in a typical fashion due to the diagnosis or there may be other unexpected symptoms or consequences that a given med are affecting without that being typical

# data[].attributes.subject
Sometimes it is impossible to know how the child will respond because either the meds don't work in a typical fashion due to the diagnosis or there may be other unexpected symptoms or consequences that a given med are affecting without that being typical

# data[].attributes.headline
Ask if we could look at the current medication list to see if there are unnecessary or redundant medications that could be removed.  Including topicals.

# data[].attributes.subject
Ask if we could look at the current medication list to see if there are unnecessary or redundant medications that could be removed.  Including topicals.

# data[].attributes.headline
accurately reflecting titration plans, sick day plans, etc--can not always put on the Rx itself

# data[].attributes.subject
accurately reflecting titration plans, sick day plans, etc--can not always put on the Rx itself

# data[].attributes.body
Pharmacy availability. Insurance approval. Copay. Out of pocket expenses. Timing of medications.

# data[].attributes.headline
simply ask if we could work together to optimize the medication regimen.

# data[].attributes.subject
simply ask if we could work together to optimize the medication regimen.

# data[].attributes.body
A discussion in person during clinic visit

# data[].attributes.headline
care conferences 1-2x yearly where all providers can discuss need for medications and be on the same page

# data[].attributes.subject
care conferences 1-2x yearly where all providers can discuss need for medications and be on the same page

# data[].attributes.headline
This patient population has multiorgan dysfunction and the mechanism for management in most cases is medication.  

# data[].attributes.subject
This patient population has multiorgan dysfunction and the mechanism for management in most cases is medication.  

# data[].attributes.headline
determining what symptoms are side effects, which are new symptoms, and which are part of the already known diagnoses

# data[].attributes.subject
determining what symptoms are side effects, which are new symptoms, and which are part of the already known diagnoses

# data[].attributes.body
If something is working, you don’t want to take it away. Change is difficult and sometimes it’s best not to rock the boat. Especially if there aren’t known side effects with the medication.

# data[].attributes.headline
parents/providers aren't patient enough; 1 bad day = we can't taper

# data[].attributes.subject
parents/providers aren't patient enough; 1 bad day = we can't taper

# data[].attributes.headline
in children with medical complexity have a primary care physician or palliative care take responsibility for prescribing, as appropriate - reach out for management opinions/consultation from specialists.

# data[].attributes.subject
in children with medical complexity have a primary care physician or palliative care take responsibility for prescribing, as appropriate - reach out for management opinions/consultation from specialists.

# data[].attributes.headline
Work at providing objective measures for therapeutic benefits for each medication, with appropriate evaluation for medication failure and discontinuation or titration.

# data[].attributes.subject
Work at providing objective measures for therapeutic benefits for each medication, with appropriate evaluation for medication failure and discontinuation or titration.

# data[].attributes.body
They see many specialists.

# data[].attributes.headline
a good pre and post record of symptoms, expected effects

# data[].attributes.subject
a good pre and post record of symptoms, expected effects

# data[].attributes.body
A conversation with the patient/caregiver. A care conference with the team would also be helpful.

# data[].attributes.headline
different teams trying to manage the same problem (pmr, pain, neuro all trying to do the same thing)

# data[].attributes.subject
different teams trying to manage the same problem (pmr, pain, neuro all trying to do the same thing)

# data[].attributes.body
They need a little help. It’s not a bad thing but it’s important to be aware of all side effects.

# data[].attributes.body
The patient could decline.

# data[].attributes.body
Have a conversation.