1. General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries
- Author
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Birgitta Weltermann, Shlomo Vinker, Radost Assenova, Jacobijn Gussekloo, Vanja Lazic, Lieve Peremans, Daiana Bonfim, Kathryn Hoffmann, Péter Torzsa, Raquel Gomez Bravo, Sandra Gintere, Aristea Missiou, Tuomas Koskela, Rosy Tsopra, Martin Sattler, Claire Collins, Marija Petek Šter, Donata Kurpas, Nicolas Rodondi, Kasper L. Johansen, Petra Bomberová Kánská, Liina Pilv, Ferdinando Petrazzuoli, Heidrun Lingner, Christian D Mallen, Hans Thulesius, Sophie Mantelli, Rosalinde K. E. Poortvliet, Zsofia Rozsnyai, Milly A. van der Ploeg, Emily Reeve, Katharine Wallis, Sven Streit, Sanda Kreitmayer Pestic, Gindrovel Dumitra, Markus Bleckwenn, Victoria Tkachenko, Rita P. A. Viegas, Katharina Tabea Jungo, Clare Luymes, Biljana Gerasimovska Kitanovska, Jungo, Katharina Tabea, Mantelli, Sophie, Rozsnyai, Zsofia, Missiou, Aristea, Reeve, Emily, Streit, Sven, University of Bern, University of Ioannina, Sts. Cyril and Methodius University, University Hospital [Essen, Germany], University of Bonn Medical Centre [Bonn], Keele University [Keele], Irish College of General Practitioners [Dublin, Irlande] (ICGP), Hospital Israelita Albert Einstein [São Paulo, Brazil], Wroclaw Medical University [Wrocław, Pologne], Lund University [Lund], Romanian Society of Family Medicine [Bucharest, Romania] (RSFM), Linnaeus University, Hannover Medical School [Hannover] (MHH), Danish College of General Practitioners [Copenhagen, Denmark] (DCGP), University of Queensland [Brisbane], University of Vienna [Vienna], University of Antwerp (UA), University of Tartu, University of Ljubljana, University of Leipzig [Leipzig, Allemagne], Societé Scientifique Luxembourgois en Medicine generale [Luxembourg City, Luxembourg] (SSLMG), Leiden University Medical Center (LUMC), Semmelweis University [Budapest], Faculty of Medicine in Hradec Kralove [Republique Tchèque], Charles University [Prague] (CU), Tel Aviv University [Tel Aviv], Faculty of Medicine [Plovdiv, Bulgarie], University of Luxembourg [Luxembourg], NOVA Medical School - Faculdade de Ciências Médicas (NMS), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Sorbonne Université (SU), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Univerzitet u Tuzli [Tuzla, Bosnie-Herzégovine], Riga Stradins University (RSU), University of Tampere [Finland], Dom zdravlja Zagreb - Centar [Zagreb, Croatia], Shupyk National Medical Academy of Postgraduate Education [Kyiv, Ukraine] (SNMAPE), University of South Australia [Adelaide], Dalhousie University [Halifax], Public Health Sciences, Ss. Cyril and Methodius University in Skopje (UKIM), Universität Bonn = University of Bonn, Wrocław Medical University, Romanian Society of Family Medicine [Bucharest] (RSFM), Danish College of General Practitioners [Copenhagen] (DCGP), Medizinische Universität Wien = Medical University of Vienna, Universität Leipzig, Societé Scientifique Luxembourgois en Medicine generale [Luxembourg City] (SSLMG), Universiteit Leiden, Semmelweis University of Medicine [Budapest], University of Hradec Králové, Tel Aviv University (TAU), Medical University of Plovdiv, École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Tampere University Hospital, Dom zdravlja Zagreb - Centar [Zagreb], Shupyk National Medical Academy of Postgraduate Education [Kiev] (SNMAPE), Malbec, Odile, Leipzig University, Tampere University, Clinical Medicine, and Primary Health Care
- Subjects
Activities of daily living ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Medizin ,Case vignette ,Old age ,Disease ,lcsh:Geriatrics ,030204 cardiovascular system & hematology ,RC952 ,MESH: Aged, 80 and over ,Deprescriptions ,0302 clinical medicine ,deprescribing ,Activities of Daily Living ,Medicine ,030212 general & internal medicine ,Primary health care ,MESH: Aged ,Aged, 80 and over ,Geriatrics ,Rehabilitation ,MESH: Polypharmacy ,3142 Public health care science, environmental and occupational health ,MESH: General Practitioners ,3. Good health ,[SDV] Life Sciences [q-bio] ,Female ,Deprescribing ,Research Article ,medicine.medical_specialty ,multimorbidity ,610 Medicine & health ,3121 Internal medicine ,MESH: Multimorbidity ,Odds ,03 medical and health sciences ,General Practitioners ,360 Social problems & social services ,Humans ,polypharmacy ,Aged ,old age ,Polypharmacy ,MESH: Humans ,business.industry ,MESH: Activities of Daily Living ,Public Health, Environmental and Occupational Health ,Multimorbidity ,MESH: Deprescriptions ,primary health care ,lcsh:RC952-954.6 ,Family medicine ,3111 Biomedicine ,Human medicine ,Geriatrics and Gerontology ,business ,MESH: Female - 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.
- Published
- 2021