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Vidonscky Lüthold R, Jungo KT, Weir KR, Adler L, Asenova R, Ares-Blanco S, Bleckwenn M, Frese T, Henrard G, Jennings AA, Kurpas D, Lazic V, Lingner H, Mannheimer S, Pereira A, Petrazzuoli F, Poortvliet RKE, Szélvári Á, Wild D, Reeve E, Rozsnyai Z, Streit S. Older Adults' Attitudes Toward Deprescribing in 14 Countries. JAMA Netw Open 2025; 8:e2457498. [PMID: 39928337 PMCID: PMC11811803 DOI: 10.1001/jamanetworkopen.2024.57498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 11/19/2024] [Indexed: 02/11/2025] Open
Abstract
Importance Better understanding of patients' attitudes toward deprescribing specific medications will inform future deprescribing interventions. Objective To investigate older adults' attitudes toward deprescribing by investigating which medications they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing. Design, Setting, and Participants This survey study was conducted from May 2022 to December 2023 in primary care settings in 14 countries. Patients aged 65 years or older taking 5 or more medications were consecutively recruited by their general practitioner (GP) and completed the questionnaire. Exposures Patient characteristics, including gender, number of medications, GP gender, education level, financial status, confidence in completing medical forms, self-rated health, satisfaction with medications, trust in the GP, and country. Main Outcomes and Measures The primary outcomes were patient attitudes toward deprescribing specific medications, as measured by responses to the question, "Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?" Multilevel multivariable logistic regression analysis was used, adjusted for clustering effect at the country level, to investigate the association between patient characteristics and interest in deprescribing. Results Of 1340 patients (mean [SD], 96 [47] patients per country), 736 (55%) were women, 580 (44%) had secondary school as their highest level of education, 1089 (82%) were satisfied with their medications, and 589 (44%) expressed they would like to deprescribe 1 or more of their medications. Patients expressed interest in deprescribing specific medications at varying levels, from 79% (86 of 109 patients) in Poland to 23% (21 of 96 patients) in Bulgaria. The 3 most reported medications patients would like to have deprescribed were diuretics (111 of 1002 medications [11%]), lipid-modifying agents (109 of 1002 medications [11%]), and agents acting on the renin-angiotensin system (83 of 1002 medications [8%]). The odds of naming at least 1 specific medication for deprescribing were lower for patients with higher medication satisfaction (odds ratio, 0.31; 95% CI, 0.21-0.47) and for patients with higher trust in their GP (odds ratio, 0.960; 95% CI, 0.930-0.998). Conclusions and Relevance In this survey study with primary care patients aged 65 years and older, patient attitudes toward deprescribing specific medications varied across countries, demonstrating that deprescribing interventions could be more impactful when adapted to specific settings and contexts. These findings highlight the importance of patient-practitioner communication in ensuring appropriate medication use.
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Affiliation(s)
- Renata Vidonscky Lüthold
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Katharina Tabea Jungo
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Division of Pharmacoepidemiology and Pharmacoeconomics and Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristie Rebecca Weir
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Limor Adler
- Department of Family Medicine, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Radost Asenova
- Department of Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Markus Bleckwenn
- Institute of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
| | - Gilles Henrard
- Department of General Practice, Faculty of Medicine, University of Liège, Liège, Belgium
| | | | - Donata Kurpas
- Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wrocław Medical University, Wrocław, Poland
| | - Vanja Lazic
- Health Center Zagreb–Centar, Zagreb, Croatia
| | - Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare, Department for Medical Psychology, Hannover, Germany
| | - Stina Mannheimer
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland Region, Sweden
| | - Anabela Pereira
- Center for Health Technology and Services Research, Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Ferdinando Petrazzuoli
- Sezione SNaMID Caserta, Caserta, Italy
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Rosalinde K. E. Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - Ágnes Szélvári
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Dorothea Wild
- Institute of Family Medicine and General Practice, University Hospital Bonn, Bonn University, Bonn, Germany
| | - Emily Reeve
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Zsofia Rozsnyai
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
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Pendergast J, Wormwood JB, Stolzmann K, Rosen AK, Jones KF, Miller CJ, Still M, Bokhour B, Hanlon JT, Simon SR, Linsky AM. Engaging Patients in Discussions About Medication Deprescribing. J Gen Intern Med 2025:10.1007/s11606-024-09346-w. [PMID: 39881120 DOI: 10.1007/s11606-024-09346-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 12/24/2024] [Indexed: 01/31/2025]
Abstract
BACKGROUND Deprescribing, intentional medication discontinuation or dose reduction, can reduce potentially inappropriate medication use and medication-related harms. Engaging patients in deprescribing discussions may increase likelihood of deprescribing and promote shared decision-making. OBJECTIVE To examine the impact of patient-directed educational brochures on patient engagement and deprescribing discussions with primary care providers (PCPs). DESIGN We mailed medication-specific brochures 2 weeks prior to each patient's PCP appointment (4/12/2021-10/7/2022), followed by a mailed survey 2 weeks after scheduled PCP visits. PARTICIPANTS Patients from three Veterans Affairs facilities with scheduled PCP appointments eligible for one of three medication-based cohorts (proton pump inhibitor, gabapentin, diabetes-hypoglycemia risk). MAIN MEASURES Our primary outcome was patient-reported deprescribing discussions with their PCP (yes/no). Descriptive statistics characterized engagement with and reactions to the brochure. Multivariable logistic regression models determined associations of patient characteristics, attitudes, and brochure-engagement with reported deprescribing discussions. KEY RESULTS Adjusting only for patient characteristics, discussions were less likely if respondents were Black (vs. White: OR 0.47, 95% CI 0.29-0.78) and more likely with higher education level (e.g., advanced degree vs. high school or less: OR 2.39, 95% CI 1.53-3.73), and adequate health literacy (OR 1.84, 95% CI 1.16-2.92). After further adjusting for general deprescribing attitudes and brochure engagement, discussions were more likely if respondents completed brochure activities (vs. did not read brochures: OR 2.23, 95% CI 1.39-3.59), contacted their PCPs prior to their visits (OR 2.47, 95% CI 1.34, 4.58), or discussed the brochure with family/friends (OR 1.72, 95% CI 1.22-2.41) or a healthcare provider (OR 3.18, 95% CI 2.08-4.85). CONCLUSIONS Patient characteristics and brochure engagement were associated with deprescribing discussions. Patient-centered deprescribing brochures can foster patient engagement and inclusion of patient perspectives into deprescribing decisions. Future studies should explore implementation strategies that promote greater deprescribing reach and adoption among patients with lower health literacy.
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Affiliation(s)
- Jacquelyn Pendergast
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA.
| | - Jolie B Wormwood
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Kelly Stolzmann
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA
| | - Amy K Rosen
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Katie Fitzgerald Jones
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Christopher J Miller
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - Michael Still
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA
| | - Barbara Bokhour
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Joseph T Hanlon
- New England Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | - Steven R Simon
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Amy M Linsky
- Center for Health Optimization and Implementation Research, VA Boston Healthcare System and VA Bedford Healthcare System, Boston and Bedford, MA, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Deprescribing attitudes and predictors among older adults attending geriatric clinics in Kuwait. PLoS One 2024; 19:e0311853. [PMID: 39700210 DOI: 10.1371/journal.pone.0311853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 09/25/2024] [Indexed: 12/21/2024] Open
Abstract
Deprescribing is defined as the reduction of medications to improve patient care. For effective deprescribing regular evaluation of medication adjustment regimens is required as it is documented to be an effective method to reduce polypharmacy and potentially inappropriate medications while improving patient well-being. Several factors, including patient-related aspects, influence the deprescribing process. Among these factors, patient willingness plays a pivotal role, making it essential to better understand their perspectives and attitudes towards medication use and deprescribing to successfully implement and maintain a deprescribing approach. We investigated the attitudes of older patients attending geriatric clinics in Kuwait toward deprescribing and identified predictors that influence their willingness to undergo this process. We enrolled patients aged ≥65 years who were attending geriatric clinics in primary care settings in Kuwait. These participants completed the revised Arabic version of the Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. The questionnaire was designed to assess the participants' willingness to participate actively in medication decision-making and their inclination toward discontinuing certain medicines. Descriptive statistics was applied to gain insight into the characteristics of the participants and their responses to the rPATD questionnaire. Binary logistic regression identified predictors influencing the desire to deprescribe among participants. The study included 535 participants, out of which 388 were analyzed, with 233 (43.6%) being women. The majority, 77% (n = 412), were aged between 65 and 74 years. Out of the total, 205 patients (38.4%) had one to two medical conditions and were prescribed between one and five medications. The participants showed a high willingness to deprescribe, and this willingness was inversely associated with sex (p = 0.15), age (p = 0.15), and polypharmacy (p = 0.044). Many older patients visiting geriatric clinics in primary care settings in Kuwait were receptive to the concept of deprescribing medications, particularly if advised by their doctor. Nevertheless, it was observed that male patients, individuals on more than 5 medications, and older age groups showed lower willingness to deprescribe.
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Affiliation(s)
- Hesah Alshammari
- Al-Sabah Hospital, Shuwaikh Medical Area, Ministry of Health, Kuwait City, Kuwait
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Eman Al-Saeed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Zamzam Ahmed
- Courses and Programmes Director, The Organisation for Professionals in Regulatory Affairs (TOPRA), London, United Kingdom
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Vordenberg SE, Nichols J, Marshall VD, Weir KR, Dorsch MP. Investigating Older Adults' Perceptions of AI Tools for Medication Decisions: Vignette-Based Experimental Survey. J Med Internet Res 2024; 26:e60794. [PMID: 39680885 DOI: 10.2196/60794] [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: 05/21/2024] [Revised: 09/07/2024] [Accepted: 11/18/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Given the public release of large language models, research is needed to explore whether older adults would be receptive to personalized medication advice given by artificial intelligence (AI) tools. OBJECTIVE This study aims to identify predictors of the likelihood of older adults stopping a medication and the influence of the source of the information. METHODS We conducted a web-based experimental survey in which US participants aged ≥65 years were asked to report their likelihood of stopping a medication based on the source of information using a 6-point Likert scale (scale anchors: 1=not at all likely; 6=extremely likely). In total, 3 medications were presented in a randomized order: aspirin (risk of bleeding), ranitidine (cancer-causing chemical), or simvastatin (lack of benefit with age). In total, 5 sources of information were presented: primary care provider (PCP), pharmacist, AI that connects with the electronic health record (EHR) and provides advice to the PCP ("EHR-PCP"), AI with EHR access that directly provides advice ("EHR-Direct"), and AI that asks questions to provide advice ("Questions-Direct") directly. We calculated descriptive statistics to identify participants who were extremely likely (score 6) to stop the medication and used logistic regression to identify demographic predictors of being likely (scores 4-6) as opposed to unlikely (scores 1-3) to stop a medication. RESULTS Older adults (n=1245) reported being extremely likely to stop a medication based on a PCP's recommendation (n=748, 60.1% [aspirin] to n=858, 68.9% [ranitidine]) compared to a pharmacist (n=227, 18.2% [simvastatin] to n=361, 29% [ranitidine]). They were infrequently extremely likely to stop a medication when recommended by AI (EHR-PCP: n=182, 14.6% [aspirin] to n=289, 23.2% [ranitidine]; EHR-Direct: n=118, 9.5% [simvastatin] to n=212, 17% [ranitidine]; Questions-Direct: n=121, 9.7% [aspirin] to n=204, 16.4% [ranitidine]). In adjusted analyses, characteristics that increased the likelihood of following an AI recommendation included being Black or African American as compared to White (Questions-Direct: odds ratio [OR] 1.28, 95% CI 1.06-1.54 to EHR-PCP: OR 1.42, 95% CI 1.17-1.73), having higher self-reported health (EHR-PCP: OR 1.09, 95% CI 1.01-1.18 to EHR-Direct: OR 1.13 95%, CI 1.05-1.23), having higher confidence in using an EHR (Questions-Direct: OR 1.36, 95% CI 1.16-1.58 to EHR-PCP: OR 1.55, 95% CI 1.33-1.80), and having higher confidence using apps (EHR-Direct: OR 1.38, 95% CI 1.18-1.62 to EHR-PCP: OR 1.49, 95% CI 1.27-1.74). Older adults with higher health literacy were less likely to stop a medication when recommended by AI (EHR-PCP: OR 0.81, 95% CI 0.75-0.88 to EHR-Direct: OR 0.85, 95% CI 0.78-0.92). CONCLUSIONS Older adults have reservations about following an AI recommendation to stop a medication. However, individuals who are Black or African American, have higher self-reported health, or have higher confidence in using an EHR or apps may be receptive to AI-based medication recommendations.
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Affiliation(s)
- Sarah E Vordenberg
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Julianna Nichols
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Vincent D Marshall
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Kristie Rebecca Weir
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
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Rababa MJ, Al Ghazo A, Hayajneh AA. Predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adult outpatients in Jordan: a cross-sectional study. BMJ Open 2024; 14:e086207. [PMID: 39581713 PMCID: PMC11590860 DOI: 10.1136/bmjopen-2024-086207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 10/23/2024] [Indexed: 11/26/2024] Open
Abstract
OBJECTIVES To examine the predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adults in Jordan. DESIGN A cross-sectional, correlational study. SETTING Data were collected by a graduate nursing student from five outpatient clinics in a selected public hospital in Jordan via inperson interviews 5 days a week over a period of 4 months. PARTICIPANTS A convenience sample of 200 older adults who regularly visited the outpatient clinics of the selected public hospital for regular check-ups during July 2023 were recruited. OUTCOME MEASURES Predictors of patients' perceived medication concerns, interest in stopping medications, perceived unimportance of medications, and beliefs about medication overuse were examined. RESULTS Increased perceived medication concerns among patients were significantly associated with older age (p=0.037), lower level of self-rated general health (p=0.002), less perceived care-provider knowledge of medications (p=0.041), higher perceived unimportance of medicines (p=0.018), less collaboration with care providers (p=0.017), being seen by a clinical pharmacist (p<0.001) and an increased number of prescribed medicines (p<0.001). Increased perceived interest in stopping medications was significantly associated with lower levels of self-rated general health (p=0.029), less perceived involvement in decision-making (p=0.013), higher perceived unimportance of medicines (p=0.002), being seen by a clinical pharmacist (p=0.024) and an increased number of prescribed medicines (p=0.001). Furthermore, increased perceived unimportance of medications among patients was significantly associated with more perceived beliefs about medication overuse (p=0.007), more perceived interest in stopping medicines (p=0.001) and greater perceived medication concerns (p=0.001). Moreover, greater perceived beliefs about medication overuse were significantly associated with older age (p=0.018), higher perceived unimportance of medicines (p=0.016), more collaboration with care providers (p=0.038), having post-traumatic disorder (p=0.018) and an increased number of prescribed medicines (p=0.038). CONCLUSIONS The current study examined predictors of medicine-related perceptions towards deprescribing inappropriate medications among older adults. Care providers should discuss the benefits of deprescribing inappropriate medications with their patients to prevent the side effects associated with long-term unnecessary use. Future studies on the effectiveness of an evidence-based deprescribing protocol on minimising the clinical side effects associated with the inappropriate prescription of medications among older adults are recommended.
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Affiliation(s)
- Mohammad J Rababa
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Ali Al Ghazo
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Audai A Hayajneh
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
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Denig P, Stuijt PJC. Comment on: Willingness to take less medication for type 2 diabetes among older patients. J Am Geriatr Soc 2024; 72:3607-3608. [PMID: 39198026 DOI: 10.1111/jgs.19175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/04/2024] [Accepted: 07/13/2024] [Indexed: 09/01/2024]
Affiliation(s)
- Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Pham Nguyen TP, Thibault D, Hamedani AG, Willis AW. Attitudes and beliefs towards medication burden and deprescribing in Parkinson disease. BMC Neurol 2024; 24:325. [PMID: 39242502 PMCID: PMC11378437 DOI: 10.1186/s12883-024-03830-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Deprescribing of potentially inappropriate medications is recommended for older adults and may improve health outcomes and quality of life in persons living with Parkinson disease (PD). Patient attitudes, beliefs, and preferences play a crucial role in the success of deprescribing interventions. We aimed to examine the attitudes and beliefs about medication burden and deprescribing among persons living with PD. METHODS We administered a survey to participants of Fox Insight, a prospective longitudinal study of persons living with PD. The survey included the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire and additional questions about adverse drug effects. We used logistic regression models to explore potential predictors of treatment dissatisfaction and willingness to deprescribe. RESULTS Of the 4945 rPATD respondents, 31.6% were dissatisfied with their current medications, and 87.1% would be willing to deprescribe medications. Male sex was associated with a greater willingness to deprescribe (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.37-1.93). A greater belief that the medication burden was high or that some medications were inappropriate was associated with treatment dissatisfaction (aORs 3.74, 95% CI 3.26-4.29 and 5.61, 95% CI 4.85-6.50), and more willingness to deprescribe (aORs 1.74, 95% CI 1.47-2.06 and 2.87, 95% CI 2.41-3.42). Cognitive impairment was the adverse drug effect participants were most concerned about when prescribed new medications to treat nonmotor symptoms. CONCLUSIONS Persons with PD are often dissatisfied with their overall medication load and are open to deprescribing. Medications that are associated with cognitive impairment might be prioritized targets for deprescribing interventions in this population.
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Affiliation(s)
- Thanh Phuong Pham Nguyen
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Center for Real-World Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Dylan Thibault
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ali G Hamedani
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Real-World Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Real-World Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Neurology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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Evin A, Bourdon M, Nizet P, Hardouin JB, Victorri-Vigneau C, Huon JF. DEprescribing: Perceptions of PAtients living with advanced cancer. A multicentre, prospective mixed observational study protocol. PLoS One 2024; 19:e0305737. [PMID: 39163415 PMCID: PMC11335145 DOI: 10.1371/journal.pone.0305737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 08/22/2024] Open
Abstract
INTRODUCTION Polypharmacy in patients with advanced cancer represents a major public health problem, leading to risk of iatrogenesis, decrease of quality of life and increase of healthcare costs. In the field of geriatrics, health policies have been developed to address polypharmacy through the use of deprescribing tools. Recently, palliative care initiatives have been introduced, yet these have not fully considered the specificities of this population, particularly their perceptions. It is therefore important to better understand patients' perceptions of deprescribing in order to adapt tools and actions to make these approaches more effective. OBJECTIVES The aim is to investigate patients' perceptions of deprescribing in palliative oncology care, and to explore factors that may influence patients' attitudes and beliefs about deprescribing and to validate a specific questionnaire (rPATD) in this population. An ancillary study will investigate the relationship between patients' health literacy and their perception of deprescribing. METHOD A prospective, observational, multicenter study will be conducted using a sequential mixed exploratory design in a population of patients living with advanced cancer and with a physician-estimated life expectancy of less than 1 year. The study will include an initial qualitative phase. Individual semi-structured interviews using a descriptive approach (thematic analysis) will be conducted (upon saturation). Following analysis of the qualitative data, a quantitative study including 300 patients will be realized to meet secondary objectives. Several data will be collected and 2 self-questionnaires will be administered: the BMQ (beliefs about medicine) and rPATD (perception of deprescribing) possibly supplemented by additional items if required by the qualitative analysis. The auxiliary study will be conducted during this second phase, using a validated self-questionnaire to assess patients' level of literacy. CONCLUSION The disparate outcomes will facilitate the understanding of the perception of deprescribing in palliative oncology care, enabling the development of tailored approaches adapted to this population. TRIAL REGISTRATION ClinicalTrials Identifier: NCT06193083.
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Affiliation(s)
- Adrien Evin
- Service de Soins Palliatifs et de Support, CHU de Nantes, Nantes Université, Nantes, France
- INSERM, Methods in Patients-centered Outcomes and Health Research, SPHERE, CHU Tours, CHU Nantes, Tours Université, Nantes Université, Nantes, France
| | - Marianne Bourdon
- INSERM, Methods in Patients-centered Outcomes and Health Research, SPHERE, CHU Tours, CHU Nantes, Tours Université, Nantes Université, Nantes, France
- Integrative Center for Oncology, Angers, Nantes, France
| | - Pierre Nizet
- INSERM, Methods in Patients-centered Outcomes and Health Research, SPHERE, CHU Tours, CHU Nantes, Tours Université, Nantes Université, Nantes, France
- Pharmacie, CHU de Nantes, Nantes Université, Nantes, France
| | - Jean-Benoit Hardouin
- INSERM, Methods in Patients-centered Outcomes and Health Research, SPHERE, CHU Tours, CHU Nantes, Tours Université, Nantes Université, Nantes, France
- Direction de la Recherche et de l’Innovation, Plateforme de Méthodologie et Biostatistique Unit, CHU de Nantes, Nantes Université, Nantes, France
| | - Caroline Victorri-Vigneau
- INSERM, Methods in Patients-centered Outcomes and Health Research, SPHERE, CHU Tours, CHU Nantes, Tours Université, Nantes Université, Nantes, France
- Centre d’évaluation et d’information sur la Pharmacodépendance-addictovigilance, CHU de Nantes, Nantes Université, Nantes, France
| | - Jean-François Huon
- INSERM, Methods in Patients-centered Outcomes and Health Research, SPHERE, CHU Tours, CHU Nantes, Tours Université, Nantes Université, Nantes, France
- Pharmacie, CHU de Nantes, Nantes Université, Nantes, France
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9
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Denig P, Stuijt PJC. Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective, and interventions to support a proactive approach. Expert Rev Clin Pharmacol 2024; 17:637-654. [PMID: 39119644 DOI: 10.1080/17512433.2024.2378765] [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: 03/04/2024] [Revised: 05/24/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering and/or lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, deprescribing rates of these so-called cardiometabolic medications are low. A review of challenges and interventions addressing these challenges in this population is pertinent. AREAS COVERED We first provide an overview of relevant deprescribing recommendations. Next, we review challenges for healthcare providers (HCPs) to deprescribe cardiometabolic medication and provide insight in the patient and caregiver perspective on deprescribing. We summarize findings from research on implementing deprescribing of cardiometabolic medication and reflect on strategies to enhance deprescribing. We have used a combination of methods to search for relevant articles. EXPERT OPINION There is a need for rigorous development and evaluation of intervention strategies aimed at proactive deprescribing of cardiometabolic medication. To address challenges at different levels, these should be multifaceted interventions. All stakeholders must become aware of the relevance of deintensifying medication in this population. Education and training for HCPs and patients should support patient-centered communication and shared decision-making. Development of procedures and tools to select eligible patients and conduct targeted medication reviews are important for implementation of deprescribing in routine care.
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Affiliation(s)
- Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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Denig P, Stuijt PJC. Barriers and Enablers for Deprescribing Diabetes Medication. J Am Med Dir Assoc 2024; 25:105075. [PMID: 38857686 DOI: 10.1016/j.jamda.2024.105075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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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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Stuijt PJC, Heringa M, van Dijk L, Faber A, Burgers JS, Feenstra TL, Taxis K, Denig P. Effects of a multicomponent communication training to involve older people in decisions to DEPRESCRIBE cardiometabolic medication in primary care (CO-DEPRESCRIBE): protocol for a cluster randomized controlled trial with embedded process and economic evaluation. BMC PRIMARY CARE 2024; 25:210. [PMID: 38862899 PMCID: PMC11165805 DOI: 10.1186/s12875-024-02465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Deprescribing of medication for cardiovascular risk factors and diabetes has been incorporated in clinical guidelines but proves to be difficult to implement in primary care. Training of healthcare providers is needed to enhance deprescribing in eligible patients. This study will examine the effects of a blended training program aimed at initiating and conducting constructive deprescribing consultations with patients. METHODS A cluster-randomized trial will be conducted in which local pharmacy-general practice teams in the Netherlands will be randomized to conducting clinical medication reviews with patients as usual (control) or after receiving the CO-DEPRESCRIBE training program (intervention). People of 75 years and older using specific cardiometabolic medication (diabetes drugs, antihypertensives, statins) and eligible for a medication review will be included. The CO-DEPRESCRIBE intervention is based on previous work and applies models for patient-centered communication and shared decision making. It consists of 5 training modules with supportive tools. The primary outcome is the percentage of patients with at least 1 cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision making, healthcare provider communication skills, health/medication-related outcomes, attitudes towards deprescribing, medication regimen complexity and health-related quality of life. Additional safety and cost parameters will be collected. It is estimated that 167 patients per study arm are needed in the final intention-to-treat analysis using a mixed effects model. Taking loss to follow-up into account, 40 teams are asked to recruit 10 patients each. A baseline and 6-months follow-up assessment, a process evaluation, and a cost-effectiveness analysis will be conducted. DISCUSSION The hypothesis is that the training program will lead to more proactive and patient-centered deprescribing of cardiometabolic medication. By a comprehensive evaluation, an increase in knowledge needed for sustainable implementation of deprescribing in primary care is expected. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov (identifier: NCT05507177).
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Affiliation(s)
- Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, PO-Box 30001, HPC AP50, UMCG, Groningen, 9700RB, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Adrianne Faber
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Jako S Burgers
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Talitha L Feenstra
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Dutch National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, PO-Box 30001, HPC AP50, UMCG, Groningen, 9700RB, The Netherlands.
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Pereira A, Veríssimo M, Ribeiro O. Influence of chronic medical conditions on older patients' willingness to deprescribe medications: a cross-sectional study. BMC Geriatr 2024; 24:315. [PMID: 38575904 PMCID: PMC10993447 DOI: 10.1186/s12877-024-04891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Aging correlates with a heightened prevalence of chronic diseases, resulting in multimorbidity affecting 60% of those aged 65 or older. Multimorbidity often leads to polypharmacy, elevating the risk of potentially inappropriate medication (PIM) use and adverse health outcomes. To address these issues, deprescribing has emerged as a patient-centered approach that considers patients' beliefs and attitudes toward medication and reduces inappropriate polypharmacy in older adults. Our study aims to investigate whether certain chronic medical conditions are associated with older patients' willingness to deprescribe medications. METHODS A cross-sectional study enrolled 192 community-dwelling individuals aged 65 or older taking at least one regular medication. Data included demographics, clinical characteristics, and responses to the Portuguese revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics characterized participants, while multiple binary logistic regression identified associations between chronic medical conditions and willingness to deprescribe. RESULTS Among the participants (median age: 72 years, 65.6% female), 91.6% had multimorbidity. The analysis revealed that willingness to deprescribe significantly increased with the presence of gastric disease (adjusted odds ratio [aOR] = 4.123; 95% CI 1.221, 13.915) and age (aOR = 1.121; 95% CI 1.009, 1.246). Conversely, prostatic pathology (aOR = 0.266; 95% CI 0.077, 0.916), higher scores in the rPATD appropriateness factor (aOR = 0.384; 95% CI 0.190, 0.773), and rPATD concerns about stopping factor (aOR = 0.450; 95% CI 0.229, 0.883) diminished patients' willingness to deprescribe. CONCLUSIONS This study highlights the intricate relationship between older patients' attitudes toward deprescribing and chronic medical conditions. We found that gastric disease was associated with an increased willingness to deprescribe medications, while prostate disease was associated with the opposite effect. Future research should explore how patients with specific diseases or groups of diseases perceive deprescribing of medications general and for specific medications, aiding in the development of targeted interventions.
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Affiliation(s)
- Anabela Pereira
- Centre for Health Technology and Services Research, Associate Laboratory RISE- Health Research Network (CINTESIS@RISE), Department of Education and Psychology, 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.
| | - Manuel Veríssimo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Oscar Ribeiro
- Centre for Health Technology and Services Research, Associate Laboratory RISE- Health Research Network (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
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Jungo KT, Weir KR, Cateau D, Streit S. Older adults' attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial. BMJ Open 2024; 14:e075325. [PMID: 38199626 PMCID: PMC10806786 DOI: 10.1136/bmjopen-2023-075325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To investigate the association between older patients' willingness to have one or more medications deprescribed and: (1) change in medications, (2) change in the appropriateness of medications and (3) implementation of prescribing recommendations generated by the electronic decision support system tested in the 'Optimising PharmacoTherapy In the Multimorbid Elderly in Primary CAre' (OPTICA) trial. DESIGN A longitudinal sub-study of the OPTICA trial, a cluster randomised controlled trial. SETTING Swiss primary care settings. PARTICIPANTS Participants were aged ≥65 years, with ≥3 chronic conditions and ≥5 regular medications recruited from 43 general practitioner (GP) practices. EXPOSURES Patients' willingness to have medications deprescribed was assessed using three questions from the 'revised Patient Attitudes Towards Deprescribing' (rPATD) questionnaire and its concerns about stopping score. MEASURES/ANALYSES Medication-related outcomes were collected at 1 year follow-up. Aim 1 outcome: change in the number of long-term medications between baseline and 12 month follow-up. Aim 2 outcome: change in medication appropriateness (Medication Appropriateness Index). Aim 3 outcome: binary variable on whether any prescribing recommendation generated during the OPTICA medication review was implemented. We used multilevel linear regression analyses (aim 1 and aim 2) and multilevel logistic regression analyses (aim 3). Models were adjusted for sociodemographic variables and the clustering effect at GP level. RESULTS 298 patients completed the rPATD, 45% were women and 78 years was the median age. A statistically significant association was found between the concerns about stopping score and the change in the number of medications over time (per 1-unit increase in the score the average number of medications use was 0.65 higher; 95% CI: 0.08 to 1.22). Other than that we did not find evidence for statistically significant associations between patients' agreement with deprescribing and medication-related outcomes. CONCLUSIONS We did not find evidence for an association between most measures of patient agreement with deprescribing and medication-related outcomes over 1 year. TRIAL REGISTRATION NUMBER NCT03724539.
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Affiliation(s)
- Katharina Tabea Jungo
- Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland
- Center for Healthcare Delivery Sciences (C4HDS), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - 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, New South Wales, Australia
| | - Damien Cateau
- Community Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Sven Streit
- Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland
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Carver J, Springer SP. Patient Attitudes Toward Deprescribing Among Community-Dwelling Older Mainers. Sr Care Pharm 2024; 39:30-41. [PMID: 38160235 DOI: 10.4140/tcp.n.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background The excess use of medications has become an increasingly prevalent issue in health care. Deprescribing can be an important tool in combating polypharmacy. Objective To assess the attitudes of community-dwelling older persons in Maine toward their medications and the concept of deprescription. An additional aim of this research was to assess the association between the revised Patient Attitudes Toward Deprescribing Questionnaire (rPATDQ) domains by polypharmacy status. Methods Researchers conducted a cross-sectional study utilizing the rPATDQ. Authors recruited older Mainers via a longitudinal cohort study through the University of New England Center for Excellence in Aging in Health. Respondents were stratified by polypharmacy status (fewer than five medications, five or more medications). Results Total daily medications ranged from 1 to 30 (average of 8.6). Overall, 83.6% of respondents agreed/strongly agreed to the statement "If my doctor said it was possible, I would be willing to stop one or more of my regular medicines." 70.6% agreed/ strongly agreed to the statement "Overall, I am satisfied with my current medicines." Those with and without polypharmacy experienced low overall medication burden and a high belief in the appropriateness of their medications. There were no statistically significant differences between polypharmacy groups. Conclusion The results of this survey indicate that the factors affecting attitudes toward deprescribing are complex. While many indicated willingness to deprescribe at least one medication, there was a high degree of satisfaction with current medication regimens. This study highlights the need for further qualitative research to identify potential barriers to deprescribing.
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Affiliation(s)
- Joshua Carver
- University of New England School of Pharmacy, Portland, Maine
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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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Alexander GC, Budnitz D, Hughes C, Maas R, Mair A, McDonald EG, Meid AD, Payne R, Seidling HM, Shakir S, Suissa S, Tannenbaum C, Schneeweiss S, Dreischulte T. Proceedings of the International Ambulatory Drug Safety Symposium: Munich, Germany, June 2023. Drug Saf 2024; 47:103-111. [PMID: 37917316 DOI: 10.1007/s40264-023-01362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Affiliation(s)
- G Caleb Alexander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street W6035, Baltimore, MD, 21205, USA.
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Daniel Budnitz
- Kenvue, Fort Washington, PA, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
- United States Public Health Service (Retired), Atlanta, GA, USA
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, UK
| | - Emily G McDonald
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rupert Payne
- Exeter Collaboration for Academic Primary Care (APEx), Exeter Medical School, University of Exeter, Exeter, UK
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Saad Shakir
- Drug Safety Research Unit, University of Portsmouth, Southampton, UK
| | - Samy Suissa
- Department of Epidemiology and Biostatistics, and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Cara Tannenbaum
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | | | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
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Srifuengfung M, Pennington BRT, Lenze EJ. Optimizing treatment for older adults with depression. Ther Adv Psychopharmacol 2023; 13:20451253231212327. [PMID: 38022834 PMCID: PMC10657532 DOI: 10.1177/20451253231212327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
This review presents a comprehensive guide for optimizing medication management in older adults with depression within an outpatient setting. Medication optimization involves tailoring the antidepressant strategy to the individual, ensuring the administration of appropriate medications at optimal dosages. In the case of older adults, this process necessitates not only adjusting or changing antidepressants but also addressing the concurrent use of inappropriate medications, many of which have cognitive side effects. This review outlines various strategies for medication optimization in late-life depression: (1) Utilizing the full dose range of a medication to maximize therapeutic benefits and strive for remission. (2) Transitioning to alternative classes (such as a serotonin and norepinephrine reuptake inhibitor [SNRI], bupropion, or mirtazapine) when first-line treatment with selective serotonin reuptake inhibitors [SSRIs] proves inadequate. (3) Exploring augmentation strategies like aripiprazole for treatment-resistant depression. (4) Implementing measurement-based care to help adjust treatment. (5) Sustaining an effective antidepressant strategy for at least 1 year following depression remission, with longer durations for recurrent episodes or severe presentations. (6) Safely discontinuing anticholinergic medications and benzodiazepines by employing a tapering method when necessary, coupled with counseling about the benefits of stopping them. Additionally, this article explores favorable medications for depression, as well as alternatives for managing anxiety, insomnia, allergy, overactive bladder, psychosis, and muscle spasm in order to avoid potent anticholinergics and benzodiazepines.
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Affiliation(s)
- Maytinee Srifuengfung
- Department of Psychiatry, Washington University School of Medicine, 660 S Euclid Avenue, PO Box 8134, St. Louis, MO 63110, USA
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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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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20
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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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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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22
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Crutzen S, Baas G, Denig P, Heringa M, Taxis K. Pharmacist-led intervention aimed at deprescribing and appropriate use of cardiometabolic medication among people with type 2 diabetes. Res Social Adm Pharm 2023; 19:783-792. [PMID: 36740525 DOI: 10.1016/j.sapharm.2022.11.009] [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: 05/22/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Potential overtreatment with cardiometabolic medication (i.e., glucose lowering medication, antihypertensives and statins) has been observed in 10-40% of older people with type 2 diabetes (T2D). OBJECTIVE The potential effects of a pharmacist-led clinical medication review targeted at T2D patients who were at high risk of hypoglycaemia will be investigated. METHODS A quasi-experimental study was conducted in 14 Dutch community pharmacies. Patients with a high risk of hypoglycaemia were identified using a previously developed algorithm. Pharmacists confirmed eligibility and selected patients for the intervention. Remaining eligible patients were included as controls receiving usual care. The primary outcome was the proportion of intervention patients for whom an action on deprescribing or appropriate use of cardiometabolic medication was implemented. After three months, changes in cardiometabolic medication were compared between the intervention and control group using a Fischer exact test. RESULTS In total 90 intervention patients and 107 control patients were included. Intervention patients had an average age of 70, used on average 10 medications, five of which were cardiometabolic medication. For half of the intervention patients an action on deprescribing cardiometabolic medication was implemented (n = 25) and/or an advice about appropriate use of cardiometabolic medication was given (n = 22). In 48% of intervention patients at least one cardiometabolic medication (e.g. insulin, sulfonylurea, diuretic, beta-blocker, statin) was either stopped or reduced in dose compared to 31% of control patients (p = 0.018). CONCLUSIONS A pharmacist-led tailored clinical medication review has the potential to increase deprescribing and improve appropriate use of cardiometabolic medication in half of T2D patients at high risk of hypoglycaemia.
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Affiliation(s)
- Stijn Crutzen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gert Baas
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, the Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, the Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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23
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Stuijt PJC, Taxis K, Denig P. Letter to the Editor: a Qualitative Study of Perspectives of Older Adults on Deintensifying Diabetes Medications. J Gen Intern Med 2023; 38:1316. [PMID: 36650324 PMCID: PMC10110832 DOI: 10.1007/s11606-022-08022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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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: 7] [Impact Index Per Article: 3.5] [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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Oktora MP, Yuniar CT, Amalia L, Abdulah R, Hak E, Denig P. Attitudes towards deprescribing and patient-related factors associated with willingness to stop medication among older patients with type 2 diabetes (T2D) in Indonesia: a cross-sectional survey study. BMC Geriatr 2023; 23:21. [PMID: 36635653 PMCID: PMC9835373 DOI: 10.1186/s12877-022-03718-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people with type 2 diabetes (T2D). It seems that many patients in low-middle-income countries are not willing to have their medicines deprescribed. This study aims to assess attitudes of Indonesian patients with T2D towards deprescribing in general and regarding specific cardiometabolic medicines, and factors influencing their willingness to stop medicines. METHODS Primary care patients with T2D of ≥60 years in Indonesia completed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Attitudes in general and for cardiometabolic medicines were reported descriptively. Proportions of patients willing to stop one or more medicines when recommended by different healthcare professionals were compared with Chi-square test. Multiple regression analysis was used to analyse the influence between patient-related factors and the willingness to stop medicines. RESULTS The survey was completed by 196 participants (median age 69 years, 73% female). The percentages willing to stop medicines were 69, 67, and 41%, when the general practitioner (GP), the specialist, or the pharmacist initiates the process (p-value < 0.001). Higher perceived burden of medicines (p-value = 0.03) and less concerns about stopping (p-value < 0.001) were associated with a higher willingness to stop medicines if proposed by the GP. Patients using multiple glucose-regulating medicines were less willing to stop (p-value = 0.02). Using complementary or alternative medicines was not associated with the willingness to stop. If proposed by their pharmacist, patients without substantial education were more willing to stop than educated patients. CONCLUSIONS Only two-thirds of older people with T2D in Indonesia were willing to stop one or more of their medicines if the GP or specialist recommended this, and even less when the pharmacist proposed this. Attention should be given to concerns about stopping specific medicines, especially among patients using multiple glucose-lowering medicines, who may be more eligible but were less willing to accept deprescribing.
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Affiliation(s)
- Monika Pury Oktora
- grid.4830.f0000 0004 0407 1981University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Cindra Tri Yuniar
- grid.434933.a0000 0004 1808 0563School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Institut Teknologi Bandung (ITB), Bandung, Indonesia
| | - Lia Amalia
- grid.434933.a0000 0004 1808 0563School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Institut Teknologi Bandung (ITB), Bandung, Indonesia
| | - Rizky Abdulah
- grid.11553.330000 0004 1796 1481Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran (UNPAD), Bandung, Indonesia
| | - Eelko Hak
- grid.4830.f0000 0004 0407 1981Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and –Economics, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- grid.4830.f0000 0004 0407 1981University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
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Nijskens C, Henstra M, Rhodius-Meester H, Yasar S, van Poelgeest E, Peters M, Muller M. Cardiovascular Risk Management in Persons with Dementia. J Alzheimers Dis 2023; 93:879-889. [PMID: 37125555 PMCID: PMC10258883 DOI: 10.3233/jad-230019] [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] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
The number of people living with dementia, such as Alzheimer's disease, is increasing worldwide. Persons with dementia often have a high risk of atherosclerotic cardiovascular disease and they are therefore theoretically eligible for treatment of hypertension and hyperlipidemia. However, in this population, beneficial and harmful effects of cardiovascular risk management (CVRM) may be different compared to older persons without cognitive impairment. Current CVRM guidelines are based on trials from which persons with dementia were excluded. In this narrative review, we will discuss how current guidelines can be translated to persons with dementia and which aspects should be taken into account when treating hypertension and hyperlipidemia to prevent major adverse cardiovascular events (MACE). Survival time is significantly shorter in persons with dementia. We therefore suggest that since the main goal of CVRM is prevention of MACE, first of all, the patient's life expectancy and treatment wishes should be evaluated. Risk assessment tools are to be used with care, as they tend to overestimate the 5- and 10-year risk of MACE and benefit from CVRM in the prevention of MACE in persons with dementia. When the clinician and patient have decided that treatment is initiated or intensified, patients should be closely monitored since they are at high risk for adverse drugs events and overtreatment due to the natural course of blood pressure in persons with dementia. In the event of intolerance or side effects, medication should be switched or withdrawn. For persons with dementia and limited life expectancy, deprescribing should be part of usual care.
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Affiliation(s)
- Charlotte Nijskens
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Marieke Henstra
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Hanneke Rhodius-Meester
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, Amsterdam, The Netherlands
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sevil Yasar
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eveline van Poelgeest
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
| | - Mike Peters
- Department of Internal and Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Majon Muller
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Geriatrics section, Amsterdam, The Netherlands
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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: 6] [Impact Index Per Article: 2.0] [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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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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Bawazeer G, Alsaad S, Almalag H, Alqahtani A, Altulaihi N, Alodhayani A, AlHossan A, Sales I. Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital. Saudi Pharm J 2022; 30:1027-1035. [PMID: 35903532 PMCID: PMC9315319 DOI: 10.1016/j.jsps.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
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Barriers and Enablers of Healthcare Providers to Deprescribe Cardiometabolic Medication in Older Patients: A Focus Group Study. Drugs Aging 2022; 39:209-221. [PMID: 35187614 PMCID: PMC8934783 DOI: 10.1007/s40266-021-00918-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 12/13/2022]
Abstract
Introduction Benefits and risks of preventive medication change over time for ageing patients and deprescribing of medication may be needed. Deprescribing of cardiovascular and antidiabetic drugs can be challenging and is not widely implemented in daily practice. Objective The aim of this study was to identify barriers and enablers of deprescribing cardiometabolic medication as seen by healthcare providers (HCPs) of different disciplines, and to explore their views on their specific roles in the process of deprescribing. Methods Three focus groups with five general practitioners, eight pharmacists, three nurse practitioners, two geriatricians, and two elder care physicians were conducted in three cities in The Netherlands. Interviews were recorded and transcribed verbatim. Directed content analysis was performed on the basis of the Theoretical Domains Framework. Two researchers independently coded the data. Results Most HCPs agreed that deprescribing of cardiometabolic medication is relevant but that barriers include lack of evidence and expertise, negative beliefs and fears, poor communication and collaboration between HCPs, and lack of resources. Having a guideline was considered an enabler for the process of deprescribing of cardiometabolic medication. Some HCPs feared the consequences of discontinuing cardiovascular or antidiabetic medication, while others were not motivated to deprescribe when the patients experienced no problems with their medication. HCPs of all disciplines stated that adequate patient communication and involving the patients and relatives in the decision making enables deprescribing. Barriers to deprescribing included the use of medication initiated by specialists, the poor exchange of information, and the amount of time it takes to deprescribe cardiometabolic medication. The HCPs were uncertain about each other’s roles and responsibilities. A multidisciplinary approach including the pharmacist and nurse practitioner was seen as the best way to support the process of deprescribing and address barriers related to resources. Conclusion HCPs recognized the importance of deprescribing cardiometabolic medication as a medical decision that can only be made in close cooperation with the patient. To successfully accomplish the process of deprescribing they strongly recommended a multidisciplinary approach.
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Oktora MP, Edwina AE, Denig P. Differences in Older Patients' Attitudes Toward Deprescribing at Contextual and Individual Level. Front Public Health 2022; 10:795043. [PMID: 35223732 PMCID: PMC8874144 DOI: 10.3389/fpubh.2022.795043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deprescribing requires patients' involvement and taking patients' attitudes toward deprescribing into account. To understand the observed variation in these attitudes, the influence of contextual-level factors, such as country or healthcare setting, should be taken into account. Methods We conducted a systematic review of studies using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire among older adults. We searched articles in Medline and Embase up to 30 June 2021. PRISMA guideline was used for the search process and reporting. We summarized the outcomes from the rPATD and compared attitudes at study population level between high or low-middle-income countries, global regions, and healthcare settings using ANOVA testing. Correlations of the rPATD outcomes with the mean age of the study populations were tested. Associations with the rPATD outcomes at individual patient level extracted from the included studies were summarized. Results Sixteen articles were included. Percentages of patients willing to stop medication were significantly lower in low-middle-income countries (<70% in Nepal and Malaysia) compared to high-income countries (>85% in USA, Australia, European countries). No significant differences were observed when results were compared by global region or by healthcare setting but a high willingness (>95%) was seen in the two studies conducted in an inpatient population. A higher mean age at study level was associated with a higher willingness to stop medication. At individual level, associations between patient characteristics, including demographics and education, and attitudes toward deprescribing showed inconsistent results. Conclusion Findings about attitudes toward deprescribing are influenced by contextual factors. Future research should pay more attention to the influence of the healthcare system and setting as well as the culture on patients' attitudes.
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Affiliation(s)
- Monika Pury Oktora
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- *Correspondence: Monika Pury Oktora
| | - Angela Elma Edwina
- Faculty of Science and Engineering, Medical Pharmaceutical Sciences Programme, University of Groningen, Groningen, Netherlands
- Unit of Geriatrics and Gerontology, Department of Public Health and Primary Care, KU Leuven – University of Leuven, Leuven, Belgium
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
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Bužančić I, Dragović P, Pejaković TI, Markulin L, Ortner-Hadžiabdić M. Exploring Patients' Attitudes Toward Deprescribing and Their Perception of Pharmacist Involvement in a European Country: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:2197-2208. [PMID: 34588769 PMCID: PMC8476111 DOI: 10.2147/ppa.s323846] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To explore how adult patients perceive deprescribing in a country with developing pharmaceutical care. PATIENTS AND METHODS This was a multicenter cross-sectional study conducted in ten community pharmacies across Croatia. Community-dwelling adults 40 years and older, taking at least one prescription medication long term, were invited to participate. The revised and validated Patients' Attitude Towards Deprescribing Questionnaire was used to investigate community-dwelling adults' opinions on potential medication discontinuation. Questions regarding the patients' perception of pharmacist competences and involvement as well as patients' preferences in deprescribing were added. Collected data were analyzed using IBM SPSS Statistics using descriptive and inferential statistical analysis. Binary logistic regression was used to explore potential predictive factors of willingness to have medication deprescribed. All tests were performed as two-tailed and a p < 0.05 was considered statistically significant. RESULTS A total of 315 adults aged 40 years and older completed the questionnaire. Majority of participants, 83.81% (95% CI, 79.72% to 87.90%) stated that they were satisfied with their medications, and 83.81% (95% CI, 79.72% to 87.90%) would be willing to deprescribe one or more medications. Participants expressed a positive attitude toward pharmacists' competences (68.89%, 95% CI, 63.75% to 74.03%) and involvement in deprescribing (71.11%, 95% CI, 66.08% to 76.14%). Participants who stated specific medication as deprescribing preference were more likely show dissatisfaction with current medication and show greater willingness to have medication deprescribed. Three factors were found to be associated with a positive attitude towards deprescribing: low concerns about stopping factor score (aOR 0.54, 95% CU=0.35-0.84; p=0.006), low appropriateness factor score (aOR 0.62, 95% CI=0.39-0.98; p=0.039), and a positive opinion on pharmacist involvement (aOR 2.35, 95% CI=1.18-4.70; p= 0.016). CONCLUSION This study showed the patient's willingness for deprescription as well as their positive attitude towards pharmacists being involved in the process. Results favour transition to a patient-centred care and shared-decision making model.
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Affiliation(s)
- Iva Bužančić
- City Pharmacies Zagreb, Zagreb, 10 000, Croatia
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10 000, Croatia
| | | | | | - Luka Markulin
- Pharmacy Unit, Psychiatric Hospital Ugljan, Ugljan, 23275, Ugljan Island, Croatia
| | - Maja Ortner-Hadžiabdić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10 000, Croatia
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