General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries
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Published:2021-01-07
Issue:1
Volume:21
Page:
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ISSN:1471-2318
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Container-title:BMC Geriatrics
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language:en
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Short-container-title:BMC Geriatr
Author:
Jungo Katharina Tabea, Mantelli Sophie, Rozsnyai Zsofia, Missiou Aristea, Kitanovska Biljana Gerasimovska, Weltermann Birgitta, Mallen Christian, Collins Claire, Bonfim Daiana, Kurpas Donata, Petrazzuoli Ferdinando, Dumitra Gindrovel, Thulesius Hans, Lingner Heidrun, Johansen Kasper Lorenz, Wallis Katharine, Hoffmann Kathryn, Peremans Lieve, Pilv Liina, Šter Marija Petek, Bleckwenn Markus, Sattler Martin, van der Ploeg Milly, Torzsa Péter, Kánská Petra Bomberová, Vinker Shlomo, Assenova Radost, Bravo Raquel Gomez, Viegas Rita P. A., Tsopra Rosy, Pestic Sanda Kreitmayer, Gintere Sandra, Koskela Tuomas H., Lazic Vanja, Tkachenko Victoria, Reeve Emily, Luymes Clare, Poortvliet Rosalinde K. E., Rodondi Nicolas, Gussekloo Jacobijn, Streit SvenORCID
Abstract
Abstract
Background
General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries.
Methods
In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions.
Results
Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57).
Interpretation
The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
Funder
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung Swiss Society of General Internal Medicine (SGAIM) Foundation National Institute for Health Research (NIHR) Applied Research Collaborations (West Midlands), the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice NHMRC-ARC Dementia Research Development Fellowship
Publisher
Springer Science and Business Media LLC
Subject
Geriatrics and Gerontology
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