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Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia

Deprescribing aims to reduce polypharmacy and inappropriate medication use. Both General Practitioners (GPs) and older adults have expressed a willingness to consider deprescribing. However, deprescribing is often deferred in practice. The aim of this study was to identify factors which influence GP...

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Autores principales: Gillespie, Robyn, Mullan, Judy, Harrison, Lindsey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087828/
https://www.ncbi.nlm.nih.gov/pubmed/36165345
http://dx.doi.org/10.1111/hsc.14058
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author Gillespie, Robyn
Mullan, Judy
Harrison, Lindsey
author_facet Gillespie, Robyn
Mullan, Judy
Harrison, Lindsey
author_sort Gillespie, Robyn
collection PubMed
description Deprescribing aims to reduce polypharmacy and inappropriate medication use. Both General Practitioners (GPs) and older adults have expressed a willingness to consider deprescribing. However, deprescribing is often deferred in practice. The aim of this study was to identify factors which influence GP and older adult decisions about deprescribing in primary care. Semi‐structured interviews were used in this qualitative study, conducted in a regional area in Australia. Participants included GPs and adults aged 65 years or older, using five or more medications and living independently in the community. Data were collected between January 2018 and May 2019. Thematic analysis was used to analyse the verbatim transcribed interviews using NVivo 12. A total of 41 interviews were conducted, 25 with older adults and 16 with GPs. Four key themes influenced deprescribing decisions: views of ageing, shared decision‐making, attitudes toward medication use and characteristics of the health care environment. Discussions of deprescribing were limited by the influence of negative stereotypes toward age and ageing, a lack of older adult participation in shared decision‐making, a positive attitude towards ongoing medication use and perception of the normality of using medications in older age. Time constraints, poor communication about prescribing information and unclear roles regarding responsibility for deprescribing also prevented discussions. Continuity of care, involvement of older adults in medication reviews and GPs who asserted their generalist role were the main factors which promoted discussion of deprescribing. GPs are well placed to discuss deprescribing with their older patients because they are trusted and can provide continuity of care. Actively encouraging and involving older adults in medication reviews in order to understand their preferences, supports shared decision‐making about deprescribing. Active involvement may also reduce the influence of negative views of ageing held by both older adults and GPs.
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spelling pubmed-100878282023-04-12 Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia Gillespie, Robyn Mullan, Judy Harrison, Lindsey Health Soc Care Community Original Articles Deprescribing aims to reduce polypharmacy and inappropriate medication use. Both General Practitioners (GPs) and older adults have expressed a willingness to consider deprescribing. However, deprescribing is often deferred in practice. The aim of this study was to identify factors which influence GP and older adult decisions about deprescribing in primary care. Semi‐structured interviews were used in this qualitative study, conducted in a regional area in Australia. Participants included GPs and adults aged 65 years or older, using five or more medications and living independently in the community. Data were collected between January 2018 and May 2019. Thematic analysis was used to analyse the verbatim transcribed interviews using NVivo 12. A total of 41 interviews were conducted, 25 with older adults and 16 with GPs. Four key themes influenced deprescribing decisions: views of ageing, shared decision‐making, attitudes toward medication use and characteristics of the health care environment. Discussions of deprescribing were limited by the influence of negative stereotypes toward age and ageing, a lack of older adult participation in shared decision‐making, a positive attitude towards ongoing medication use and perception of the normality of using medications in older age. Time constraints, poor communication about prescribing information and unclear roles regarding responsibility for deprescribing also prevented discussions. Continuity of care, involvement of older adults in medication reviews and GPs who asserted their generalist role were the main factors which promoted discussion of deprescribing. GPs are well placed to discuss deprescribing with their older patients because they are trusted and can provide continuity of care. Actively encouraging and involving older adults in medication reviews in order to understand their preferences, supports shared decision‐making about deprescribing. Active involvement may also reduce the influence of negative views of ageing held by both older adults and GPs. John Wiley and Sons Inc. 2022-09-27 2022-11 /pmc/articles/PMC10087828/ /pubmed/36165345 http://dx.doi.org/10.1111/hsc.14058 Text en © 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Gillespie, Robyn
Mullan, Judy
Harrison, Lindsey
Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia
title Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia
title_full Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia
title_fullStr Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia
title_full_unstemmed Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia
title_short Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia
title_sort factors which influence the deprescribing decisions of community‐living older adults and gps in australia
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087828/
https://www.ncbi.nlm.nih.gov/pubmed/36165345
http://dx.doi.org/10.1111/hsc.14058
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