Understanding older patients' willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries

Older adults' attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial

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.

Attitude towards medication deprescribing among older patients attending the geriatric centre: a cross-sectional survey in Southwest Nigeria

OBJECTIVES

This study set out to assess older people's perception of their medications, attitude towards medication use and their willingness to have medications deprescribed in a geriatric centre in Southwestern Nigeria.

DESIGN AND SETTING

A cross-sectional study was conducted at the Chief Tony Anenih Geriatric Centre, University of Ibadan, using an interviewer-administered questionnaire. The questionnaire used was a revised version of the Patient's Attitude Towards Deprescribing Questionnaire. Descriptive statistics, and multivariate and bivariate analyses were performed using SPSS V.23. Statistical significance was set at p<0.05.

PARTICIPANTS

415 older patients aged ≥60 years who attended the geriatric centre in University College Hospital Ibadan between April and July 2022.

MAIN OUTCOME MEASURE

The primary outcome was the willingness of the older person to deprescribe if recommended by the physician.

RESULTS

The mean age of the participants was 69.6±6.4 years, and 252 (60.7%) were female. Overall, the willingness and positive attitude to medication deprescribing among respondents were 60.5% and 89.7%, respectively. Factors significantly associated with willingness to deprescribe were financial self-support (p=0.021), having no previous hospital admission (p=0.009), better-perceived quality of health relative to peers (p<0.0001), polypharmacy (p=0.003), and the domains burden of medication (p=0.007), medication appropriateness (p<0.0001), concerns about stopping medications (p<0.0001) and involvement with medications (p<0.0001). The predictive factors for improved willingness to deprescribe were direct involvement with medications (OR=2.463; 95% CI 1.501 to 4.043, p<0.0001), medication appropriateness (OR=0.462; 95% CI 0.254 to 0.838, p=0.011) and concerns about stopping medications (OR=2.031; 95% CI 1.191 to 3.463, p=0.009).

CONCLUSION

Participants demonstrated greater willingness to deprescribe if the physicians recommended it. Predictive factors that may influence willingness to deprescribe were direct involvement with medications, appropriateness of medication and concerns about stopping medications.