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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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Pereira A, Ribeiro O, Veríssimo M. Predictors of older patients' willingness to have medications deprescribed: A cross-sectional study. Basic Clin Pharmacol Toxicol 2023; 133:703-717. [PMID: 37070165 DOI: 10.1111/bcpt.13874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Deprescribing is a complex process requiring a patient-centred approach. One frequently expressed deprescribing barrier is patients' attitudes and beliefs towards deprescribing. This study aimed to identify the predictors of patients' willingness to have medications deprescribed. METHODS A cross-sectional study was conducted with community-dwelling patients aged ≥65 who are taking at least one regular medication. Data collection included patients' demographic and clinical characteristics and the Portuguese revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics were used to present the patients' characteristics. Multiple binary logistic regression analysis was performed to identify the predictors of the patients' willingness to have medications deprescribed. RESULTS One hundred ninety-two participants (median age 72 years; 65.6% female) were included. Most (83.33%) were willing to have medications deprescribed, and the predictors were age (adjusted odds ratio [aOR] = 1.136; 95% CI 1.026, 1.258), female sex (aOR = 3.036; 95% CI 1.059, 8.708) and the rPATD concerns about stopping factor (aOR = 0.391; 95% CI 0.203, 0.754). CONCLUSIONS Most patients were willing to have their medications deprescribed if it is recommended by their doctors. Older age and female sex increased the odds of willingness to deprescribe; higher concerns about stopping medications decreased the odds. These findings suggest that addressing patients' concerns about stopping their medicines may contribute to deprescribing success.
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Affiliation(s)
- Anabela Pereira
- Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research at the Associate Laboratory RISE, Health Research Network (CINTESIS@RISE), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Oscar Ribeiro
- Department of Education and Psychology of the University of Aveiro, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research at the Associate Laboratory RISE, Health Research Network (CINTESIS@RISE), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
| | - Manuel Veríssimo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Coimbra, Portugal
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Gadisa DA, Gebremariam ET, Yimer G, Deresa Urgesa E. Attitudes of Older Adult Patients and Caregivers Towards Deprescribing of Medications in Ethiopia. Clin Interv Aging 2023; 18:1129-1143. [PMID: 37522072 PMCID: PMC10378541 DOI: 10.2147/cia.s400698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/17/2023] [Indexed: 08/01/2023] Open
Abstract
Background Deprescribing is essential for reducing inappropriate medication use and polypharmacy. For a holistic approach, it is essential to know how older adult patients and their caregivers perceive deprescribing. Objective To assess the attitude of older adult patients and caregivers towards deprescribing medication at Ambo University Referral Hospital. Methodology Institutional-based cross-sectional study was conducted using the revised Patients' Attitude Towards Deprescribing tool (rPATD). The data was analyzed using the SPSS-25 software. Backward linear regression and logistic regression were used to measure association between outcome and determinant variables. The two-sided P-value ≤0.05 with 95% confidence interval was utilized for reporting significant factors. Results One hundred fifty-six (81.3%) of the respondents (ie, 85.0% of older adult and 77.2% of caregivers) agreed to stop one or more of their regular medications if the physician said it was possible despite 98 (51.0%) of them (ie, 49.0% of older adult and 53.3% of caregivers) being satisfied with their/their care recipient's medications. On the overall aggregate mean score, the respondents had a neutral position (2.6-3.59) regarding the burden and concerns of stopping medications whereas the majority of them disagree (1.0-2.59) with the inappropriateness of the medication they were taking and agreed (3.6-5.0) with the need for their involvement in treatment decision making. Concerns about stopping medicine scores (AOR = 0.440, 95% CI = 0.262-0.741, P = 0.035) and perceived levels of medication inappropriateness (AOR = 0.653, 95% CI = 0.456-0.936, P = 0.020) was significantly associated with the willingness to discontinue and overall satisfaction with their medicine regimen respectively. Conclusion The majority of older adult patients and caregivers would like to deprescribe if the physicians recommended it. The perceived concerns of stopping and inappropriateness of the medicines were associated with the willingness to deprescribe and overall satisfaction with their medicine respectively. Healthcare providers should prompt the deprescribing process with older adult patients and caregivers by addressing their concerns about stopping medications.
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Affiliation(s)
- Diriba Alemayehu Gadisa
- Pharmacy Department, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia, Ethiopia
| | | | - Getnet Yimer
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Global Genomics & Health Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Efa Deresa Urgesa
- Contract Director Management Department, Ethiopian Pharmaceutical Supply Service, Addis Ababa, Ethiopia
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Mohammed MA, Harrison J, Milosavljevic A, Chan AHY. Attitude towards deprescribing and its association with frailty and complexity of medication regimen: A survey of older inpatients in a district health board in New Zealand. BMC Geriatr 2023; 23:166. [PMID: 36959598 PMCID: PMC10035261 DOI: 10.1186/s12877-023-03878-2] [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: 01/12/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Older inpatients, particularly those with frailty, have increased exposure to complex medication regimens. It is not known whether frailty and complexity of medication regimens influence attitudes toward deprescribing. This study aimed to investigate (1) older inpatients' attitudes toward deprescribing; (2) if frailty and complexity of medication regimen influence attitudes and willingness to deprescribe - a relationship that has not been investigated in previous studies. METHODS In this cross-sectional study, older adults (≥ 65 years) recruited from general medicine and geriatric services in a New Zealand hospital completed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Hospital frailty risk score (HFRS) was calculated using diagnostic codes and other relevant information present at the time of index hospital admission; higher scores indicate higher frailty risk. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI); higher scores indicate greater complexity. Logistic regression analysis was used to identify predictors of attitudes and willingness to deprescribe. RESULTS A total of 222 patients were included in the study, the median age was 83 years and 63% were female. One in two patients reported feeling they were taking too many medications, and 1 in 5 considered their medications burdensome. Almost 3 in 4 (73%) wanted to be involved in decision-making about their medications, and 4 in 5 (84%) were willing to stop one or more of their medications if their prescriber said it was possible. Patients with higher MRCI had increased self-reported medication burden (adjusted odds ratio (AOR) 2.6, 95% CI 1.29, 5.29) and were more interested in being involved in decision-making about their medications (AOR 1.8, CI 0.99, 3.42) than those with lower MRCI. Patients with moderate HFRS had lower odds of willingness to deprescribe (AOR 0.45, CI 0.22,0.92) compared to the low-risk group. Female patients had a lower desire to be involved in decision-making. The oldest old age group( > 80 years) had lower self-reported medication burden and were less likely to want to try stopping their medications. CONCLUSION Most older inpatients wanted to be involved in decision-making about their medications and were willing to stop one or more medications if proposed by their prescriber. Medication complexity and frailty status influence patients' attitudes toward deprescribing and thus should be taken into consideration when making deprescribing decisions. Further research is needed to investigate the relationship between frailty and the complexity of medication regimens.
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Affiliation(s)
- Mohammed A Mohammed
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Aleksandra Milosavljevic
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Ouellet N, Bergeron AS, Gagnon E, Cossette B, Labrecque CA, Sirois C. Prescribing and deprescribing in very old age: perceptions of very old adults, caregivers and health professionals. Age Ageing 2022; 51:6827077. [PMID: 36413585 DOI: 10.1093/ageing/afac244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND although they are major consumers of medications, there is little evidence-based data to guide prescribing and deprescribing of medications for very old adults (80+ years). OBJECTIVES to discover the perceptions of very old adults, caregivers and health professionals in order to further examine the clinical and ethical issues raised by prescribing and deprescribing in very old age. METHODS individual interviews were conducted with very old adults (n = 10) and caregivers (n = 6), whereas group interviews were conducted with health professionals (n = 11). The themes covered included perceptions of medication use, polypharmacy, deprescribing and patient-health professional relationships. Thematic analysis was used to identify areas of convergence and divergence. RESULTS very old adults are satisfied with the medications they are taking, do not see the need to reduce their medication use and consider their doctor as the expert who should make the decisions regarding treatment. The perceptions of caregivers are similar to those of older adults, whereas health professionals believe that very old adults take a lot of inappropriate medications and list multiple barriers to deprescribing. All participants describe a normalisation of medication use with ageing. CONCLUSION there is a dichotomy between the perception of the very old adults/caregivers and that of health professionals regarding the safety of medication in very old age. A cultural change regarding medication use seems essential to optimise therapy and support deprescribing in clinical practice since the potential issues raised by researchers do not resonate with the main stakeholders.
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Affiliation(s)
- Nicole Ouellet
- Département des Sciences Infirmières, Université du Québec à Rimouski, Rimouski, Québec, Canada
| | - Anne-Sophie Bergeron
- Département des Sciences Infirmières, Université du Québec à Rimouski, Rimouski, Québec, Canada
| | - Eric Gagnon
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada.,VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux, Québec, Canada
| | - Benoit Cossette
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada.,Research Center on Aging, Integrated University Health and Social Services Center of Estrie-Sherbrooke University Hospital Center, Sherbrooke, Québec, Canada
| | - Cory A Labrecque
- Faculté de Théologie et de Sciences Religieuses, Université Laval, Québec, Canada
| | - Caroline Sirois
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada.,VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux, Québec, Canada.,Faculté de Pharmacie, Université Laval, Laval, Québec, Canada
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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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