Katharina Tabea Jungo1, Sophie Mantelli1, Zsofia Rozsnyai1, Aristea Missiou2, Biljana Gerasimovska Kitanovska3, Birgitta Weltermann4,5, Christian Mallen6, Claire Collins7, Daiana Bonfim8, Donata Kurpas9, Ferdinando Petrazzuoli10, Gindrovel Dumitra11, Hans Thulesius10,12, Heidrun Lingner13, Kasper Lorenz Johansen14, Katharine Wallis15, Kathryn Hoffmann16, Lieve Peremans17,18, Liina Pilv19, Marija Petek Šter20, Markus Bleckwenn21, Martin Sattler22, Milly van der Ploeg23, Péter Torzsa24, Petra Bomberová Kánská25, Shlomo Vinker26, Radost Assenova27, Raquel Gomez Bravo28, Rita P A Viegas29, Rosy Tsopra30,31, Sanda Kreitmayer Pestic32, Sandra Gintere33, Tuomas H Koskela34, Vanja Lazic35, Victoria Tkachenko36, Emily Reeve37,38, Clare Luymes23,39, Rosalinde K E Poortvliet23, Nicolas Rodondi1,40, Jacobijn Gussekloo23,41, Sven Streit42. 1. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. 2. Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. 3. Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia. 4. Institute for General Practice, University of Duisburg-Essen, University Hospital Essen, Essen, Germany. 5. Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany. 6. Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG,, United Kingdom. 7. Irish College of General Practitioners, Dublin, Ireland. 8. Hospital Israelita Albert Einstein, São Paulo, Brazil. 9. Family Medicine Department, Wroclaw Medical University, Wrocław, Poland. 10. Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden. 11. Romanian Society of Family Medicine, Bucharest, Romania. 12. Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden. 13. Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany. 14. Danish College of General Practitioners, Copenhagen, Denmark. 15. Primary Care Clinical Unit, the University of Queensland, Brisbane, Australia. 16. Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria. 17. Department of Primary and Interdisciplinary Care, University Antwerp, Antwerp, Belgium. 18. Department of Nursing and Midwifery, University Antwerp, Antwerp, Belgium. 19. Department of Family Medicine, University of Tartu, Tartu, Estonia. 20. Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. 21. Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany. 22. SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg City, Luxembourg. 23. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands. 24. Department of Family Medicine, Semmelweis University, Budapest, Hungary. 25. Department of Social Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic. 26. Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 27. Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria. 28. Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg. 29. Family Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical School, Lisbon, Portugal. 30. INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006, Paris, France. 31. Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France. 32. Family Medicine Department, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina. 33. Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University, Riga, Latvia. 34. Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. 35. Dom zdravlja Zagreb - Centar, Zagreb, Croatia. 36. Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine. 37. Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia. 38. Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada. 39. UWV (Employee Insurance Agency), Leiden, the Netherlands. 40. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 41. Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands. 42. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. sven.streit@biham.unibe.ch.
Abstract
BACKGROUND: General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
BACKGROUND: General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
Entities:
Keywords:
Deprescribing; Multimorbidity; Old age; Polypharmacy; Primary health care
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