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Geremie T, Guiguet-Auclair C, Laroche ML, Mely P, Gerbaud L, Blanquet M. Deprescribing in older adults in a French community: a questionnaire study on patients' beliefs and attitudes. BMC Geriatr 2024; 24:562. [PMID: 38937665 PMCID: PMC11212408 DOI: 10.1186/s12877-024-05165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND General practitioners (GPs) have a central role to play on reduction of polypharmacy and deprescribing. This study aimed to assess beliefs and attitudes towards deprescribing in patients, aged 65 years or older in primary care, and to identify factors associated with deprescribing and their willingness to stop medication. METHODS A questionnaire study was performed between 23 May and 29 July 2022 on patients aged 65 years or older attending a GP's surgery in a French area. We used the French version of the revised Patients' Attitudes Towards Deprescribing self-report questionnaire (rPATD), which measures four subscales ("Burden", "Appropriateness", "Concerns about stopping" and, "Involvement"), patients' willingness to stop one of their regular medicines, and patients' satisfaction with their current medicines. RESULTS The study enrolled 200 patients. Median age was 76 years old (IQR 71-81), 55% were women, and 42.5% took 5 or more medications per day. Although most patients (92.5%) were satisfied with their current medicines, 35% were reluctant to stop medications they had been taking for a long time, and 89.5% were willing to stop medication if asked to by their GP. Patients aged less than 75 years old reported more concerns about stopping. Women and patients with higher educational attainment showed significantly higher involvement in medication management. CONCLUSIONS The majority of older adults were willing to stop one or more of their regular medicines if asked to do so by their GP. GPs should address deprescribing into their current practice.
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Affiliation(s)
| | - Candy Guiguet-Auclair
- Public Health, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Auvergne INP, Clermont Auvergne College, University Hospital of Clermont-Ferrand, CNRS Pascal Institute, Clermont-Ferrand, France
| | - Marie Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology- Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France
- UR 24134 (Ageing, Frailty, Prevention, e-Health), Institute Omega Health, University of Limoges, Limoges, France
| | - Pierre Mely
- Surgery of Riom-ès-Montagnes, Riom-ès-Montagnes, France
| | - Laurent Gerbaud
- Public Health, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Auvergne INP, Clermont Auvergne College, University Hospital of Clermont-Ferrand, CNRS Pascal Institute, Clermont-Ferrand, France
| | - Marie Blanquet
- Public Health, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
- Clermont Auvergne INP, Clermont Auvergne College, University Hospital of Clermont-Ferrand, CNRS Pascal Institute, Clermont-Ferrand, France.
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Nguyen-Soenen J, Weir KR, Jungo KT, Perrot B, Fournier JP. Does missing data matter in the revised Patients' Attitudes Towards Deprescribing questionnaire? A systematic review and two case analyses. Res Social Adm Pharm 2024; 20:296-307. [PMID: 38168621 DOI: 10.1016/j.sapharm.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/10/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed to capture beliefs and perceptions of patients about deprescribing. In general, handling of missing data is underreported in survey studies. Underlying mechanisms related to missing data may impact the findings from survey studies. OBJECTIVES The aim of this study was to assess the missing data in studies using the rPATD questionnaire through a systematic review and datasets from two studies. METHODS First, this review updated a systematic review on the rPATD (and other versions). We searched Medline via OVID, EMBASE, Scopus, Web of Science until 31st January 2023. Missing data reporting and methods to handle them were collected. Second, data from two deprescribing studies were analyzed using three methods of missing data handling: complete case analysis, personal mean substitution, and multiple imputation. We compared the scores from each domain and the associations of the domains with two questions from the rPATD to highlight how using different methods can influence the interpretation of study findings. RESULTS We identified 49 studies: 31 (63 %) from this study and 18 (37 %) from the original systematic review. The question or domain with the most missing data could be identified in 9 studies (18.4 %). Missing data management was reported in 19 studies (38.8 %). In one case analysis, the "Burden" domain was significantly associated with the question "I would like to try stopping one of my medicines to see how I feel without it" using complete case analysis (p = 0.044) or multiple imputation (p = 0.038), but not when using personal mean substitution (p = 0.057). CONCLUSIONS Missing data and methods used to handle missing data were underreported in studies using the rPATD questionnaire. The methods should be chosen carefully as our analyses from two distinct studies suggest that they may impact the interpretation of the findings from the questionnaire.
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Affiliation(s)
- Jérôme Nguyen-Soenen
- SPHERE - UMR INSERM 1246, Nantes Université, Université de Tours, France; Département de Médecine Générale, Faculté de Médecine, Nantes Université, France.
| | - Kristie Rebecca Weir
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bastien Perrot
- SPHERE - UMR INSERM 1246, Nantes Université, Université de Tours, France; Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Jean-Pascal Fournier
- SPHERE - UMR INSERM 1246, Nantes Université, Université de Tours, France; Département de Médecine Générale, Faculté de Médecine, Nantes Université, France
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Villena-Moya A, Granero R, Chiclana-Actis C, Potenza MN, Blycker GR, Demetrovics Z, Bőthe B, Steward T, Fernández-Aranda F, Jiménez-Murcia S, Mestre-Bach G. Spanish Validation of the Long and Short Versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6) in Adolescents. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:673-687. [PMID: 37845419 DOI: 10.1007/s10508-023-02700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 06/26/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
Although 1-14% of adolescents may experience problematic pornography use (PPU), psychometrically sound instruments for assessing PPU in Spanish-speaking adolescents are scarce. Given the advantages of the different forms of the Problematic Pornography Consumption Scale (PPCS), the aim of the present study was to assess the psychometric properties of the PPCS and PPCS-6, and to examine associations between PPU and age among boys and girls. Two school-based adolescent samples were recruited in Spain (n = 650; Mage = 16.0 [SD = 1.1]; 50% girls and 50% boys) and Mexico (n1, 160; Mage = 15.8 [SD = 1.1]; 68% girls) to assess the psychometric properties of the PPCS and PPCS-6. Confirmatory factor analysis was applied and convergent and discriminant validity with other measures related to PPU was also tested. The results provided empirical support for the six-factor structure of the PPCS and the one-factor structure of the PPCS-6. Boys with older age showed higher levels of tolerance than girls on the PPCS in both countries. Both the PPCS and the PPCS-6 may be considered valid psychometric instruments for the assessment of PPU in Spanish-speaking adolescents from Spain and Mexico.
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Affiliation(s)
- Alejandro Villena-Moya
- Centro de Investigación, Transferencia e Innovación, Universidad Internacional de la Rioja, La Rioja, 26006, Spain
- Unidad de Sexología Clínica y Salud Sexual de la Consulta Dr. Carlos Chiclana, Madrid, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Chiclana-Actis
- Centro de Investigación, Transferencia e Innovación, Universidad Internacional de la Rioja, La Rioja, 26006, Spain
- Unidad de Sexología Clínica y Salud Sexual de la Consulta Dr. Carlos Chiclana, Madrid, Spain
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
| | - Gretchen R Blycker
- College of Nursing, University of Rhode Island, Kingston, RI, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada
- Département de Psychologie, Université du Québec á Trois-Rivières, Trois-Rivières, QC, Canada
| | - Trevor Steward
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Fernando Fernández-Aranda
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Psychology, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Psychology, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gemma Mestre-Bach
- Centro de Investigación, Transferencia e Innovación, Universidad Internacional de la Rioja, La Rioja, 26006, Spain.
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Bardoczi JB, Brunner L, Spinewine A, Rodondi N, Aubert CE. Older Adult Attitudes toward Deprescribing Statins in Primary Cardiovascular Prevention Versus General Medications. Gerontol Geriatr Med 2024; 10:23337214241245918. [PMID: 38628165 PMCID: PMC11020750 DOI: 10.1177/23337214241245918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background: There is little evidence for statins for primary cardiovascular prevention in older adults. Consequently, it is important to assess patient attitudes toward the use of statins, which might differ from attitudes toward other medications. We aimed to describe older patient attitudes toward deprescribing statins versus general medications. Methods: We conducted a survey using the revised Patients' Attitudes Toward Deprescribing questionnaire in its original version and adapted to statin use in adults ≥65 years taking a statin for primary prevention. Results: Among the 47 participants (mean age 74.6 years), 42 (89%) were satisfied with their current therapy, but still willing to stop ≥1 of their medications upon their doctor's advice. About 68% (N = 32) were satisfied with their statin therapy, while 83% (N = 39) would accept to consider deprescribing. Twenty-six (55%) participants were concerned about missing future benefits when stopping their general medications and 17 (36%) when stopping their statin. Eight (17%) participants believed they were experiencing side effects of statins and twice as many for general medication (38%, N = 18). Conclusion: Our study provides insight about differences and similarities in patient attitudes toward deprescribing general medications and statins in primary prevention. This information could support patient-centered conversations and shared-decision making about deprescribing.
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Affiliation(s)
| | | | - Anne Spinewine
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Centre Hospitalier Universitaire (CHU) UCL Namur, Yvoir, Belgium
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Bucsa C, Onea M, Rusu A, Farcas A, Porojan M, Dumitrascu D, Iaru I, Leucuta D, Mogosan C, Reeve E, Moga D. Translation, cultural adaptation and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults. Res Social Adm Pharm 2023; 19:1471-1479. [PMID: 37495451 DOI: 10.1016/j.sapharm.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice. OBJECTIVES To translate, culturally adapt and validate the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing. METHODS The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined. RESULTS We translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects. CONCLUSIONS The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.
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Affiliation(s)
- C Bucsa
- Pharmacovigilance Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - M Onea
- Pharmacovigilance Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - A Rusu
- Department of Diabetes and Nutrition Diseases, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - A Farcas
- Pharmacovigilance Research Center, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - M Porojan
- 2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - D Dumitrascu
- 2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - I Iaru
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - D Leucuta
- Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Mogosan
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - E Reeve
- Monash University, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Melbourne, VIC, Australia; University of South Australia, Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, Adelaide, SA, Australia
| | - D Moga
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA; Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
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Pétein C, Spinewine A, Laroche ML, Niquille A, Henrard S. Adaptation and validation of the revised Patients' Attitudes towards Deprescribing (rPATD) questionnaire for benzodiazepine receptor agonists. Res Social Adm Pharm 2023:S1551-7411(23)00274-7. [PMID: 37301641 DOI: 10.1016/j.sapharm.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire explores older adults' views on deprescribing in general. Those views may differ, however, when the target is a specific drug such as benzodiazepine receptor agonists (BZRA). OBJECTIVE This study aimed to adapt the 22-item French rPATD questionnaire to create a BZRA-specific instrument and to assess the psychometric properties of this new tool. METHODS The adaptation of the questionnaire comprised 3 steps: 1) item transformation during group discussions with 8 healthcare providers and 8 BZRA users (aged ≥65 years), 2) pre-test of the questionnaire with 12 other older adults to ensure items understanding, 3) evaluation of the psychometric properties of the new questionnaire with 221 older BZRA users recruited in Belgium, France, and Switzerland. Construct validity was assessed using exploratory factor analysis (EFA), internal consistency with Cronbach's alpha, and test-retest reliability with intraclass correlation coefficient (ICC). RESULTS After the pre-test, the questionnaire had 24 items (19 adapted from the French rPATD, 3 removed, and 5 added). The EFA, however, found that several items performed poorly. Eleven items were consequently removed, based on statistical performance and clinical relevance. Three factors were extracted from the EFA performed on the 11 retained items and were named "Concerns about stopping BZRA", "BZRA inappropriateness", and "Dependence on BZRA". The questionnaire also includes two global questions about willingness to reduce BZRA dosage and willingness to discontinue BZRA. All factors showed acceptable internal consistency (0.68 ≤ Cronbach's alpha ≤0.74). Two factors showed acceptable test-retest reliability. The "Concerns about stopping BZRA" factor was found to vary over time (ICC [95%CI]: 0.35[-0.02; 0.64]). CONCLUSIONS We developed and validated a 13-item questionnaire to evaluate the attitudes of older people towards BZRA deprescribing. Despite some limitations, this questionnaire appears to be a useful tool for facilitating shared decision-making on BZRA deprescribing.
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Affiliation(s)
- Catherine Pétein
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Emmanuel Mounier 72, 1200, Brussels, Belgium.
| | - Anne Spinewine
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Emmanuel Mounier 72, 1200, Brussels, Belgium; Pharmacy Department, Université Catholique de Louvain, CHU UCL Namur, Rue Dr Gaston Therasse 1, 5530, Yvoir, Belgium.
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex Limoges, France; UR 24134 Vie-Santé, Faculty of Medicine, University of Limoges, Campus Marcland, 2 Rue du Docteur Marcland, 87025, Limoges, France.
| | - Anne Niquille
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland; Community Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, 30 Quai Ernest-Ansermet, CH-1211, Geneva 4, Switzerland.
| | - Séverine Henrard
- Clinical Pharmacy research group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Emmanuel Mounier 72, 1200, Brussels, Belgium; Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle-aux-Champs 30, 1200, Brussels, Belgium.
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Badou JP. Les patients face à la déprescription. ACTUALITES PHARMACEUTIQUES 2023. [DOI: 10.1016/j.actpha.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Nusair MB, Khasawneh R, Al-azzam S, Al-Shuqairat T, Khair ZM, Arabyat R. Attitudes towards adherence and deprescribing among polypharmacy patients: a cross-sectional study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
Deprescribing is the process of optimization of medication regimens through cessation of potentially inappropriate or unnecessary medications or adjustment of doses with the goal of managing polypharmacy and improving outcomes. Deprescribing potentially improves adherence by reducing polypharmacy. This study aimed to assess polypharmacy patients’ adherence attitudes and their attitudes towards deprescribing.
Methods
A cross-sectional study that targeted polypharmacy patients at outpatient clinics at King Abdullah University Hospital. The inclusion criteria were (1) patients ≥18 years old, (2) patients taking five or more medications, and (3) patients who do not require a caregiver or assistance at home. We excluded patients that showed any signs of moderate or severe cognitive impairment. Patients who met the inclusion/exclusion criteria were interviewed by a clinical pharmacist and completed two survey instruments: revised Patients’ Attitudes Toward Deprescribing (rPATD) and Adherence Attitude Inventory (AAI).
Key findings
In total, 501 patients took part in this study. Over half of the participants were not satisfied with their current medicines and over 70% of them perceived that their current medications are a burden to them and would like their prescribers to initiate deprescribing. The majority of the participants have low to medium adherence attitudes primarily due to ineffective patient–provider communication. Logistic regression analysis revealed that self-efficacy, commitment to adherence, education and age were significantly associated with participants’ willingness to stop one or more of their medications.
Conclusions
Our findings suggest that polypharmacy patients have negative attitudes towards their medication therapy and favour deprescribing. These reported attitudes had been associated with negative adherence attitudes. Study findings offer schematic direction for future investigations of the role of adherence on key health-related outcomes in patients on polypharmacy. Furthermore, research is warranted to investigate the impact of deprescribing on polypharmacy patients’ medication adherence.
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Affiliation(s)
- Mohammad B Nusair
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University , Irbid , Jordan
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University , Fort Lauderdale, FL , USA
| | - Rawand Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Sayer Al-azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Tala Al-Shuqairat
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Zaid M Khair
- Faculty of Pharmacy, Yarmouk University , Irbid , Jordan
| | - Rasha Arabyat
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University , Irbid , Jordan
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Lee HG, Kwon S, Jang BH, Jeon JP, Lee YS, Jung WS, Moon SK, Cho KH. A Study on the Perceptions of Korean Older Adult Patients and Caregivers about Polypharmacy and Deprescribing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11446. [PMID: 36141719 PMCID: PMC9517474 DOI: 10.3390/ijerph191811446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Polypharmacy is continuously increasing among older adults. The resultant potentially inappropriate medications (PIMs) can be harmful to patient health. Deprescribing refers to stopping or reducing PIMs. In this study, the current status of polypharmacy and willingness of older adults to deprescribe were investigated among patients and caregivers who are not associated with one another. The survey used the Korean translated version of the revised Patients' Attitude Towards Deprescribing (rPATD) Scale. Data were collected through an online survey of 500 participants (250 patients and caregivers each) in this study. The following results were found for patients and caregivers, respectively: 74.8% and 63.6% felt their number of medications was high, 64.4% and 55.6% desired to reduce their medications, 70.4% and 60.8% were concerned about medication discontinuation, 63.2% and 61.2% had a good understanding of their medications, 77.6% and 76.4% were willing to be well informed, and 79.6% and 72% wanted to reduce the number of medications if medically feasible. Patients and caregivers commonly agreed to the burden of the number of medications they were taking, and were willing to reduce the number of medications if the doctor said it was possible. Doctors should consider this information during the deprescribing process, and promote deprescription while involving patients and caregivers in the decision-making process.
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Affiliation(s)
- Han-Gyul Lee
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Seungwon Kwon
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24253, Korea
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Korea
| | - Woo-Sang Jung
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Sang-Kwan Moon
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
| | - Ki-Ho Cho
- Kyung Hee University Medical Center, Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea
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Pereira A, Ribeiro O, Veríssimo M. Translation, cross-cultural adaptation and validation of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to Portuguese: Older adults version. Res Social Adm Pharm 2022; 19:123-132. [PMID: 36115808 DOI: 10.1016/j.sapharm.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deprescribing is a patient-centered approach to managing inappropriate polypharmacy that faces several barriers, including patients' attitudes and beliefs about medications that need to be considered. For this purpose, the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire is a helpful instrument, but until now, there is no Portuguese version. OBJECTIVES To translate and validate the rPATD questionnaire (older adults version) to Portuguese. METHODS The rPATD questionnaire was translated and cross-culturally adapted using forward-backward translation and pre-testing. A cross-sectional study with 192 older adults aged ≥65 years taking at least 1 regular medication was conducted for validity assessment. Participants were recruited by convenience sampling in 3 Portuguese outpatient rehabilitation medicine clinics. Psychometric properties were evaluated through face and content validity; construct validity, by assessing structural validity through exploratory factor analysis, hypotheses testing, including concurrent validity and cross cultural validity; reliability with internal consistency; and item-total correlation. Floor and ceiling effects were examined. RESULTS The exploratory factor analysis (EFA) revealed a 4-factor structure that explains 51.08% of the total variance, as in the original rPATD. These 4 factors are related to the level of involvement in medication management, beliefs in the appropriateness of medication, perceived burden of medication, and concerns about stopping medications. Factor loadings ranged from 0.226 to 0.800; 2 items scored <0.3, and no cross-loading was found. The exclusion of the 2 items loading <0.3 in the EFA showed no significant improvement in factor loading or internal consistency, so the item structure was maintained. In hypothesis testing, 78% of the correlations were correctly predicted. The 4 factors internal consistency was generally acceptable, with Cronbach's alpha ranging from 0.638 to 0.830. The item-total correlation ranged between 0.223 and 0.7. CONCLUSION The Portuguese rPATD questionnaire for older adults presents globally good or acceptable psychometric properties.
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Affiliation(s)
- Anabela Pereira
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal; Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Manuel Veríssimo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
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Roux B, Rakheja B, Sirois C, Niquille A, Pétein C, Ouellet N, Spinewine A, Sibille FX, Laroche ML. Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study. Eur J Clin Pharmacol 2022; 78:1633-1646. [PMID: 35896803 DOI: 10.1007/s00228-022-03368-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Successful deprescribing requires understanding the attitudes of older adults and caregivers towards this process. This study aimed to capture these attitudes in four French-speaking countries and to investigate associated factors. METHODS A multicenter cross-sectional study was conducted by administrating the French version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Belgium, Canada, France, and Switzerland. Community-dwelling or nursing home older adults ≥ 65 years taking ≥ 1 prescribed medications and caregivers of older adults with similar characteristics were included. Multivariate logistic regressions were carried out to examine factors associated with willingness to deprescribe. RESULTS A total of 367 older adults (79.3 ± 8.7 years, 63% community-dwelling, 54% ≥ 5 medications) and 255 unrelated caregivers (64.4 ± 12.6 years) of care recipients (83.4 ± 7.9 years, 52% community-dwelling, 69% ≥ 5 medications) answered the questionnaire. Among them, 87.5% older adults and 75.6% caregivers would be willing to stop medications if the physician said it was possible. Reluctance to stop a medication taken for a long time was expressed by 46% of both older adults and caregivers. A low score for the factor "concerns about stopping" (older adults: aOR: 0.21; 95% CI: 0.07-0.59), and a high score for the factor "involvement" (older adults: aOR: 2.66; 95% CI: 1.01-7.07; caregivers: aOR: 11.28; 95% CI: 1.48-85.91) were associated with willingness to deprescribe. CONCLUSIONS A significant proportion of older adults and caregivers of French-speaking countries are open to deprescribing. Despite this apparent willingness, deprescribing conversations in clinical practice remains marginal, emphasizing the importance of optimizing the integration of existing tools such as rPATD.
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Affiliation(s)
- Barbara Roux
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France
| | | | - Caroline Sirois
- Faculty of Pharmacy, Laval University, Quebec, Canada.,Centre of Excellence On Aging of Quebec, Quebec, Canada.,Centre de recherche sur les soins et les Services de premieres lignes de l'Université Laval, Quebec, Canada
| | - Anne Niquille
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Community Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium
| | - Nicole Ouellet
- Department of Health, University of Quebec at Rimouski, Rimouski, Canada
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Yvoir, Belgium
| | - François-Xavier Sibille
- Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium.,Institute of Health and Society, UCLouvain, Brussels, Belgium
| | - Marie-Laure Laroche
- Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France. .,Unité VIESANTE - UR 24134 (Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France.
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de Juan-Roldán JI, Castillo-Jimena M, González-Hevilla A, Sánchez-Sánchez C, García-Ruiz AJ, Gavilán-Moral E. Cross-cultural adaptation and psychometric validation of a Spanish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. BMJ Open 2022; 12:e050678. [PMID: 35450888 PMCID: PMC9024262 DOI: 10.1136/bmjopen-2021-050678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Successful deprescribing depends largely on factors related to the patient. The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed with the objective of evaluating the beliefs and attitudes of older adults and caregivers towards deprescribing. The present study was designed to validate a Spanish version of the rPATD questionnaire, both the versions for older adults and for caregivers, through a qualitative validation phase and the analysis of its psychometric properties. DESIGN Cross-sectional validation study. SETTING Primary care settings in Málaga (Spain). PARTICIPANTS A sample of 120 subjects (60 patients with polypharmacy and 60 caregivers of patients with polypharmacy) were enrolled in the study. MAIN OUTCOME MEASURES In the qualitative validation stage, the rPATD questionnaire was translated/back-translated and subjected to a cross-cultural adaptation to evaluate its face validity and feasibility. Next, its psychometric properties were assessed. Confirmatory factor analysis was used to evaluate construct validity. Internal consistency was determined using Cronbach's alpha test. Criterion validity through pre-established hypotheses from the Beliefs about Medicines Questionnaire (BMQ) Specific-Concerns Scale, and test-retest reliability were analysed. RESULTS Confirmatory factor analysis verified the four-factor structure of the original rPATD questionnaire, with items loading into four factors: involvement, burden, appropriateness and concerns about stopping. The Cronbach's alpha coefficient of the factors ranged from 0.683 to 0.879. The burden, appropriateness and concerns about stopping factors were significantly correlated with the BMQ Specific-Concerns Score, except for the concerns about stopping factor in the older adults' version. The consistency of the items between administration times (test-retest reliability) showed weighted Cohen's kappa values ranging from moderate (>0.4) to very good (>0.8). CONCLUSIONS The Spanish version of the rPATD questionnaire is a feasible, valid and reliable instrument to evaluate attitudes towards deprescribing in Spanish-speaking patients and caregivers.
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Affiliation(s)
- Jose Ignacio de Juan-Roldán
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
- Laboratory of Innovative Practices in Polymedication and Health, Plasencia, Cáceres, Spain
- Centro de Emergencias Sanitarias 061, Málaga, Andalusia, Spain
| | - Marcos Castillo-Jimena
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
- Group C-08: Multiprofesional Teaching Unit of Community and Family Care, Health District Málaga-Guadalhorce, Biomedical Research Institute of Málaga -IBIMA-, Málaga, Spain
- Primary Care Health Centre Campillos, Northern Málaga Integrated Healthcare Area, Andalusian Health Service, Campillos, Málaga, Spain
| | - Alba González-Hevilla
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
- Group C-08: Multiprofesional Teaching Unit of Community and Family Care, Health District Málaga-Guadalhorce, Biomedical Research Institute of Málaga -IBIMA-, Málaga, Spain
| | | | - Antonio J García-Ruiz
- Department of Pharmacology and Paediatrics, Universidad de Málaga. Facultad de Medicina, Málaga, Spain
| | - Enrique Gavilán-Moral
- Laboratory of Innovative Practices in Polymedication and Health, Plasencia, Cáceres, Spain
- Primary Care Health Office Mirabel, Extremadura Health Service, Cáceres, Spain
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Rakheja B, Sirois C, Ouellet N, Roux B, Laroche ML. Attitudes Toward Deprescribing in Older Adults and Caregivers: A Survey in Quebec, Canada. J Appl Gerontol 2022; 41:1376-1384. [PMID: 35246001 PMCID: PMC9024025 DOI: 10.1177/07334648211069553] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to describe attitudes toward deprescribing among older adults and caregivers. We recruited 110 adults 65 years and above using at least one prescribed medication for at least 3 months, and 95 unrelated caregivers (18+) of older adults with such characteristics, who answered the validated French version of the revised Patients’ Attitudes Towards Deprescribing questionnaire. More older adults (84.5%) than caregivers (70.5%) (p = .007) would be willing to stop at least one medication if the doctor said it was possible. Conversely, 93.5% of older adults and 78.9% of caregivers were satisfied with the current medications taken (p = .0024). The results did not vary according to age, sex, number of medications taken, education level, or residency. Thus, older adults and caregivers are disposed to undertake deprescribing, regardless of sociodemographic characteristics. However, relying solely on satisfaction with current medications may not be sufficient to identify relevant deprescribing opportunities.
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Affiliation(s)
- Bianca Rakheja
- Faculté de Médecine, 12369Université Laval, Québec, Canada
| | - Caroline Sirois
- Faculté de Pharmacie, 4440Université Laval, Québec, Canada.,Centre d'excellence sur le Vieillissement de Québec, Québec, Canada.,VITAM, Centre de Recherche en Santé durable, Québec, Canada
| | - Nicole Ouellet
- Département des Sciences Infirmières, 14846Université du Québec à Rimouski, Rimouski, Canada
| | - Barbara Roux
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur Les Médicaments, 36715CHU de Limoges, Limoges, France
| | - Marie-Laure Laroche
- Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur Les Médicaments, 36715CHU de Limoges, Limoges, France.,Laboratoire Vie-Santé, Faculté de Médecine de Limoges, Limoges, France
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14
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Nguyen-Soenen J, Rat C, Gaultier A, Schirr-Bonnans S, Tessier P, Fournier JP. Effectiveness of a multi-faceted intervention to deprescribe proton pump inhibitors in primary care: protocol for a population-based, pragmatic, cluster-randomized controlled trial. BMC Health Serv Res 2022; 22:219. [PMID: 35177042 PMCID: PMC8851828 DOI: 10.1186/s12913-022-07496-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 02/07/2023] Open
Abstract
Background Inappropriately using proton pump inhibitors (PPI) is associated with severe adverse drug reactions and may have major consequences on healthcare costs. Deprescribing (the process by which a healthcare professional supervises the withdrawal of an inappropriate medication, to manage polypharmacy and improve outcomes) should be considered when an inappropriate PPI prescription is identified. Deprescribing interventions directed solely to prescribers have limited efficacy and are rarely targeted to patients. The aim of this trial is to assess the efficacy of a multi-faceted intervention with patients and general practitioners (GPs) to deprescribe PPI. Methods We will conduct a pragmatic, cluster-randomized, population-based, controlled trial in two regions of Western France. GPs with practices with over 100 patients, and their adult patient to whom over 300 defined daily doses (DDD) of PPIs have been dispensed in the year before baseline will be included. A total of 1300 GPs and 33,000 patients will be cluster-randomized by GPs practices. Three arms will be compared: i) a multi-faceted intervention associating a) a patient education brochure about PPI deprescribing sent directly to patients (the brochure was designed using a mixed-methods study), and b) a personalized letter with the Bruyere’s PPI deprescribing algorithm sent to their respective GPs, or ii) a single intervention where only the GPs received the letter and algorithm, or iii) no intervention. The primary outcome will be PPI deprescribing, defined as the proportion of patients achieving at least a 50% decrease in the amount of PPI dispensed to them (DDD/year) at 12 months compared to baseline. Secondary outcomes will include incremental cost-utility ratio (using EQ-5D-5L scale and National Health Insurance’s database), acid rebound (using the Gastroesophageal Reflux Disease Impact Scale), and the patients’ attitudes towards deprescribing (using the French rPATD). Discussion Based on previous trials, we anticipate more than 10% “successful PPI deprescribing” in the multi-faceted intervention compared to the single intervention on GPs and the control arm. The study has been funded through a national grant and will be launched in autumn 2020, for early results by the end of 2022. Trial registration Clinicaltrials.gov NCT04255823; first registered on February 5, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07496-3.
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Affiliation(s)
- Jérôme Nguyen-Soenen
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France. .,SPHERE - UMR INSERM 1246, Université de Nantes, Université de Tours, Nantes, France.
| | - Cédric Rat
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France
| | - Aurélie Gaultier
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France.,Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Solène Schirr-Bonnans
- CHU de Nantes, Service Évaluation Économique et Développement des Produits de Santé, Nantes Université, Nantes, France
| | - Philippe Tessier
- SPHERE - UMR INSERM 1246, Université de Nantes, Université de Tours, Nantes, France.,CHU de Nantes, Service Évaluation Économique et Développement des Produits de Santé, Nantes Université, Nantes, France
| | - Jean-Pascal Fournier
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, Nantes, France.,SPHERE - UMR INSERM 1246, Université de Nantes, Université de Tours, Nantes, France
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15
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How Willing Are Patients or Their Caregivers to Deprescribe: a Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:3830-3840. [PMID: 34173200 PMCID: PMC8642501 DOI: 10.1007/s11606-021-06965-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Polypharmacy is associated with the increased use of potentially inappropriate medications, where the risks of medicine use outweigh its benefits. Stopping medicines (deprescribing) that are no longer needed can be beneficial to reduce the risk of adverse events. We summarized the willingness of patients and their caregivers towards deprescribing. METHODS A systematic search was conducted in four databases from inception until April 30, 2021 as well as search of citation of included articles. Studies that reported patients' and/or their caregivers' attitude towards deprescribing quantitatively were included. All studies were independently screened, reviewed, and data extracted in duplicates. Patients and caregivers willingness to deprescribe their regular medication was pooled using random effects meta-analysis of proportions. RESULTS Twenty-nine unique studies involving 11,049 participants were included. All studies focused on the attitude of the patients towards deprescribing, and 7 studies included caregivers' perspective. Overall, 87.6% (95% CI: 83.3 to 91.4%) patients were willing to deprescribe their medication, based upon the doctors' suggestions. This was lower among caregivers, with only 74.8% (49.8% to 93.8%) willing to deprescribe their care recipients' medications. Patients' or caregivers' willingness to deprescribe were not influenced by study location, study population, or the number of medications they took. DISCUSSION Most patients and their caregivers were willing to deprescribe their medications, whenever possible and thus should be offered a trial of deprescribing. Nevertheless, as these tools have a poor predictive ability, patients and their caregivers should be engaged during the deprescribing process to ensure that the values and opinions are heard, which would ultimately improve patient safety. In terms of limitation, as not all studies may published the methods and results of measurement they used, this may impact the methodological quality and thus our findings. OPEN SCIENCE FRAMEWORK REGISTRATION: https:// osf.io/fhg94.
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Bouhuys M, Lexmond WS, Dijkstra G, Lobatón T, Louis E, van Biervliet S, Groen H, Guardiola J, Rheenen PV. Efficacy of anti-TNF dosing interval lengthening in adolescents and young adults with inflammatory bowel disease in sustained remission (FREE-study): protocol for a partially randomised patient preference trial. BMJ Open 2021; 11:e054154. [PMID: 34732500 PMCID: PMC8572401 DOI: 10.1136/bmjopen-2021-054154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/15/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Anti-tumour necrosis factor (TNF) therapy has greatly improved treatment outcomes in patients with inflammatory bowel disease (IBD), but long-term use is associated with cutaneous reactions, susceptibility to infections and frequent injections or hospital visits. Several non-controlled studies have demonstrated that dose reduction is feasible for a subset of patients, provided that early detection of a disease flare is possible. Here, we aim to compare the effectiveness of interval lengthening with standard dosing in maintaining remission in young patients with IBD. METHODS AND ANALYSIS In this international, prospective, non-inferiority, partially randomised patient preference trial, we aim to recruit 148 patients aged 12-25 years with luminal Crohn's disease or ulcerative colitis in sustained remission (ie, three consecutive in-range faecal calprotectin (FC) results or recently confirmed endoscopic remission). In the interventional arm, the dosing interval will be lengthened from 8 to 12 weeks for infliximab users and from 2 to 3 weeks for adalimumab users. In the control group, standard dosing will be continued. Rapid tests will be performed for FC every 4 weeks and for anti-TNF trough levels every 12 weeks. The primary outcome is the cumulative incidence of out-of-range FC results at 48-week follow-up. Secondary endpoints include time to get out-of-range FC results, cumulative incidence of adverse effects, proportion of patients progressing to loss of response and identification of predictors of successful interval lengthening. ETHICS AND DISSEMINATION The protocol has been approved by the Medical Ethics Review Committee of the University Medical Centre Groningen and is pending at the other participating centres. Results will be disseminated in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER EudraCT number: 2020-001811-26; ClinicalTrials.gov Identifier: NCT04646187. Protocol version 4, date 17 September 2021.
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Affiliation(s)
- Marleen Bouhuys
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Centre Groningen, Beatrix Childrens Hospital, Groningen, The Netherlands
| | - Willem S Lexmond
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Centre Groningen, Beatrix Childrens Hospital, Groningen, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Triana Lobatón
- Department of Gastroenterology, University Hospital Ghent, Gent, Belgium
| | - Edouard Louis
- Department of Gastroenterology, Central University Hospital of Liege, Liege, Belgium
| | | | - Henk Groen
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jordi Guardiola
- Department of Gastroenterology, Bellvitge University Hospital, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Centre Groningen, Beatrix Childrens Hospital, Groningen, The Netherlands
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Michiels Y. De la dispensation adaptée à la déprescription. ACTUALITES PHARMACEUTIQUES 2021. [DOI: 10.1016/j.actpha.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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