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How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study
BACKGROUND: Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186124/ https://www.ncbi.nlm.nih.gov/pubmed/30314468 http://dx.doi.org/10.1186/s12875-018-0856-9 |
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author | Mantelli, Sophie Jungo, Katharina Tabea Rozsnyai, Zsofia Reeve, Emily Luymes, Clare H. Poortvliet, Rosalinde K. E. Chiolero, Arnaud Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven |
author_facet | Mantelli, Sophie Jungo, Katharina Tabea Rozsnyai, Zsofia Reeve, Emily Luymes, Clare H. Poortvliet, Rosalinde K. E. Chiolero, Arnaud Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven |
author_sort | Mantelli, Sophie |
collection | PubMed |
description | BACKGROUND: Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population. METHODS: GPs took an online survey that presented case-vignettes of a frail oldest-old patient with and without history of cardiovascular disease (CVD) and asked if they would deprescribe any of seven medications. We calculated percentages of GPs willing to deprescribe at least one medication in the case with CVD and compared these with the case without CVD using paired t-tests. We also included open-ended questions to capture reasons for deprescribing and asked which factors could influence their decision to deprescribe by asking for their agreement on a 5-point-Likert-scale. RESULTS: Of the 282 GPs we invited, 157 (56%) responded: 73% were men; mean age was 56. In the case-vignette without CVD, 98% of GPs deprescribed at least one medication (usually cardiovascular preventive medications) stating it had no indication nor benefit. They would lower the dose or prescribe pain medication as needed to reduce side effects. Their response was much the same when the patient had a history of CVD. GPs reported they were influenced by ‘risk’ and ‘benefit’ of medications, ‘quality of life’, and ‘life expectancy’, and prioritized the patient’s wishes and priorities when deprescribing. CONCLUSION: Swiss GPs were willing to deprescribe cardiovascular preventive medication when it lacked indication but tended to retain pain medication. Developing tools for GPs to assist them in balancing the risks and benefits of medication in the context of patient values may improve deprescribing activities in practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-018-0856-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6186124 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-61861242018-10-19 How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study Mantelli, Sophie Jungo, Katharina Tabea Rozsnyai, Zsofia Reeve, Emily Luymes, Clare H. Poortvliet, Rosalinde K. E. Chiolero, Arnaud Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven BMC Fam Pract Research Article BACKGROUND: Many oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population. METHODS: GPs took an online survey that presented case-vignettes of a frail oldest-old patient with and without history of cardiovascular disease (CVD) and asked if they would deprescribe any of seven medications. We calculated percentages of GPs willing to deprescribe at least one medication in the case with CVD and compared these with the case without CVD using paired t-tests. We also included open-ended questions to capture reasons for deprescribing and asked which factors could influence their decision to deprescribe by asking for their agreement on a 5-point-Likert-scale. RESULTS: Of the 282 GPs we invited, 157 (56%) responded: 73% were men; mean age was 56. In the case-vignette without CVD, 98% of GPs deprescribed at least one medication (usually cardiovascular preventive medications) stating it had no indication nor benefit. They would lower the dose or prescribe pain medication as needed to reduce side effects. Their response was much the same when the patient had a history of CVD. GPs reported they were influenced by ‘risk’ and ‘benefit’ of medications, ‘quality of life’, and ‘life expectancy’, and prioritized the patient’s wishes and priorities when deprescribing. CONCLUSION: Swiss GPs were willing to deprescribe cardiovascular preventive medication when it lacked indication but tended to retain pain medication. Developing tools for GPs to assist them in balancing the risks and benefits of medication in the context of patient values may improve deprescribing activities in practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12875-018-0856-9) contains supplementary material, which is available to authorized users. BioMed Central 2018-10-12 /pmc/articles/PMC6186124/ /pubmed/30314468 http://dx.doi.org/10.1186/s12875-018-0856-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Mantelli, Sophie Jungo, Katharina Tabea Rozsnyai, Zsofia Reeve, Emily Luymes, Clare H. Poortvliet, Rosalinde K. E. Chiolero, Arnaud Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study |
title | How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study |
title_full | How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study |
title_fullStr | How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study |
title_full_unstemmed | How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study |
title_short | How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study |
title_sort | how general practitioners would deprescribe in frail oldest-old with polypharmacy — the less study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186124/ https://www.ncbi.nlm.nih.gov/pubmed/30314468 http://dx.doi.org/10.1186/s12875-018-0856-9 |
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