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Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study

OBJECTIVES: To explore general practitioners’ (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support. DESIGN: Semistructured interviews. SETTING: Dutch general practi...

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Autores principales: van Middelaar, Tessa, Ivens, Sophie D, van Peet, Petra G, Poortvliet, Rosalinde K E, Richard, Edo, Pols, A Jeannette, Moll van Charante, Eric P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914897/
https://www.ncbi.nlm.nih.gov/pubmed/29678989
http://dx.doi.org/10.1136/bmjopen-2017-020871
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author van Middelaar, Tessa
Ivens, Sophie D
van Peet, Petra G
Poortvliet, Rosalinde K E
Richard, Edo
Pols, A Jeannette
Moll van Charante, Eric P.
author_facet van Middelaar, Tessa
Ivens, Sophie D
van Peet, Petra G
Poortvliet, Rosalinde K E
Richard, Edo
Pols, A Jeannette
Moll van Charante, Eric P.
author_sort van Middelaar, Tessa
collection PubMed
description OBJECTIVES: To explore general practitioners’ (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support. DESIGN: Semistructured interviews. SETTING: Dutch general practice. PARTICIPANTS: Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached. RESULTS: GPs appeared reluctant to start AHM, especially in patient >80 years. High systolic blood pressure and history of cardiovascular disease or diabetes were enablers to start or intensify treatment. Reasons to refrain from this were frailty and patient preference. GPs described a tendency to continue AHM regimens unchanged, influenced by daily time constraints, automated prescription routines and anticipating discomfort when disturbing patients’ delicate balance. GPs were only inclined to deprescribe AHM in terminally ill patients or after prolonged achievement of target levels in combination with side effects or patient preference. Deprescription was facilitated when GPs had experience with patients showing increased quality of life after deprescription and was withheld by anticipated regret (ie, GPs’ fear of a stroke after deprescribing). GPs felt insufficient guidance from current guidelines, especially on deprescription. CONCLUSIONS: GPs are reluctant to start or deprescribe AHM in older people and have a propensity to continue AHM within a daily routine that insufficiently supports critical medication review. (De)prescription is influenced by patient preferences and anticipated regret and current guidelines provide insufficient guidance.
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spelling pubmed-59148972018-04-27 Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study van Middelaar, Tessa Ivens, Sophie D van Peet, Petra G Poortvliet, Rosalinde K E Richard, Edo Pols, A Jeannette Moll van Charante, Eric P. BMJ Open General practice / Family practice OBJECTIVES: To explore general practitioners’ (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support. DESIGN: Semistructured interviews. SETTING: Dutch general practice. PARTICIPANTS: Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached. RESULTS: GPs appeared reluctant to start AHM, especially in patient >80 years. High systolic blood pressure and history of cardiovascular disease or diabetes were enablers to start or intensify treatment. Reasons to refrain from this were frailty and patient preference. GPs described a tendency to continue AHM regimens unchanged, influenced by daily time constraints, automated prescription routines and anticipating discomfort when disturbing patients’ delicate balance. GPs were only inclined to deprescribe AHM in terminally ill patients or after prolonged achievement of target levels in combination with side effects or patient preference. Deprescription was facilitated when GPs had experience with patients showing increased quality of life after deprescription and was withheld by anticipated regret (ie, GPs’ fear of a stroke after deprescribing). GPs felt insufficient guidance from current guidelines, especially on deprescription. CONCLUSIONS: GPs are reluctant to start or deprescribe AHM in older people and have a propensity to continue AHM within a daily routine that insufficiently supports critical medication review. (De)prescription is influenced by patient preferences and anticipated regret and current guidelines provide insufficient guidance. BMJ Publishing Group 2018-04-20 /pmc/articles/PMC5914897/ /pubmed/29678989 http://dx.doi.org/10.1136/bmjopen-2017-020871 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle General practice / Family practice
van Middelaar, Tessa
Ivens, Sophie D
van Peet, Petra G
Poortvliet, Rosalinde K E
Richard, Edo
Pols, A Jeannette
Moll van Charante, Eric P.
Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
title Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
title_full Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
title_fullStr Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
title_full_unstemmed Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
title_short Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study
title_sort prescribing and deprescribing antihypertensive medication in older people by dutch general practitioners: a qualitative study
topic General practice / Family practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914897/
https://www.ncbi.nlm.nih.gov/pubmed/29678989
http://dx.doi.org/10.1136/bmjopen-2017-020871
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