What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey

BMC Geriatrics

Rosalinde K. E. Poortvliet¹  Jacobijn Gussekloo²  Zsofia Rozsnyai³  Sven Streit³  Nicolas Rodondi⁴  Katharina Tabea Jungo⁵  Emily Reeve⁶ 

[1] Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands;Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands;Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands;Institute of Primary Health Care Bern (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland;Institute of Primary Health Care Bern (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland;Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;Institute of Primary Health Care Bern (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland;Graduate School for Health Sciences, University of Bern, Bern, Switzerland;Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia;NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia;Geriatric Medicine Research and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada;

关键词: Deprescribing;    Polypharmacy;    Multimorbidity;    Patient attitudes;    Older adults;    General practice;   

DOI  :  10.1186/s12877-020-01843-x

来源: Springer

【 摘 要 】

BackgroundMultimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe given time constraints and few recommendations from guidelines. Further, patient related barriers and enablers to deprescribing have to be accounted for. The aim of this study was to identify barriers and enablers to deprescribing as reported by older adults with polypharmacy and multimorbidity.MethodsWe conducted a survey among participants aged ≥70 years, with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 chronic medications). We invited Swiss GPs, to recruit eligible patients who then completed a paper-based survey on demographics, medications and chronic conditions. We used the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire and added twelve additional Likert scale questions and two open-ended questions to assess barriers and enablers towards deprescribing, which we coded and categorized into meaningful themes.ResultSixty four Swiss GPs consented to recruit 5–6 patients each and returned 300 participant responses. Participants were 79.1 years (SD 5.7), 47% female, 34% lived alone, and 86% managed their medications themselves. Sixty-seven percent of participants took 5–9 regular medicines and 24% took ≥10 medicines. The majority of participants (77%) were willing to deprescribe one or more of their medicines if their doctor said it was possible. There was no association with sex, age or the number of medicines and willingness to deprescribe. After adjustment for baseline characteristics, there was a strong positive association between willingness to deprescribe and saying that because they have a good relationship with their GP, they would feel that deprescribing was safe OR 11.3 (95% CI: 4.64–27.3) and agreeing that they would be willing to deprescribe if new studies showed an avoidable risk OR 8.0 (95% CI 3.79–16.9). From the open questions, the most mentioned barriers towards deprescribing were patients feeling well on their current medicines and being convinced that they need all their medicines.ConclusionsMost older adults with polypharmacy are willing to deprescribe. GPs may be able to increase deprescribing by building trust with their patients and communicating evidence about the risks of medication use.

【 授权许可】

CC BY