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Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study
BACKGROUND: Deprescribing has been recommended for managing polypharmacy but deprescribing preventive medication in older patients is still uncommon. We aimed to investigate older patients’ barriers to and enablers of deprescribing cardiometabolic medication. METHODS: Two focus groups were conducted...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468428/ https://www.ncbi.nlm.nih.gov/pubmed/32973509 http://dx.doi.org/10.3389/fphar.2020.01268 |
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author | Crutzen, Stijn Baas, Gert Abou, Jamila van den Born-Bondt, Tessa Hugtenburg, Jacqueline G. Bouvy, Marcel L. Heringa, Mette Taxis, Katja Denig, Petra |
author_facet | Crutzen, Stijn Baas, Gert Abou, Jamila van den Born-Bondt, Tessa Hugtenburg, Jacqueline G. Bouvy, Marcel L. Heringa, Mette Taxis, Katja Denig, Petra |
author_sort | Crutzen, Stijn |
collection | PubMed |
description | BACKGROUND: Deprescribing has been recommended for managing polypharmacy but deprescribing preventive medication in older patients is still uncommon. We aimed to investigate older patients’ barriers to and enablers of deprescribing cardiometabolic medication. METHODS: Two focus groups were conducted among patients ≥70 years with polypharmacy, including cardiometabolic medication. Purposive sampling through four community pharmacies was used in two regions in the Netherlands. A topic list was developed using literature and the theoretical domains framework (TDF). The meetings were audio recorded, transcribed verbatim and coded using thematic coding, attribute coding and the TDF. In addition, patients were categorized on attitudes towards medication and willingness to stop. RESULTS: The meetings were attended by 17 patients and 1 caregiver (71 to 84 years). In total 15 barriers and 13 enablers were identified within four themes, partly related to beliefs, fears and experiences regarding using or stopping medication, and partly related to the relationship with the health care professional and the conditions to stop. Some patients attributed their wellbeing to their medication and were therefore unwilling to stop. Reducing cardiometabolic medication because of less strict treatment targets confused some patients and was a barrier to deprescribing. Having options to monitor clinical measurements and restart medication were enablers. Patients were only willing to stop cardiometabolic medication when this was proposed by a HCP they trusted. Patients with a positive attitude towards medication varied in their willingness to stop cardiometabolic medication. Patients with a negative attitude towards medication were generally willing to stop medication but still perceived several barriers and may consider some medication as being essential. CONCLUSION: Fears, beliefs, and experiences regarding using and stopping medication as well as trust in the HCP influence willingness to have medication deprescribed. Attitudes towards medication in general do not necessarily translate into willingness or unwillingness to stop specific medication. For deprescribing cardiometabolic medication, patient involvement when setting new treatment targets and monitoring the effects on short-term outcomes are important. |
format | Online Article Text |
id | pubmed-7468428 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74684282020-09-23 Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study Crutzen, Stijn Baas, Gert Abou, Jamila van den Born-Bondt, Tessa Hugtenburg, Jacqueline G. Bouvy, Marcel L. Heringa, Mette Taxis, Katja Denig, Petra Front Pharmacol Pharmacology BACKGROUND: Deprescribing has been recommended for managing polypharmacy but deprescribing preventive medication in older patients is still uncommon. We aimed to investigate older patients’ barriers to and enablers of deprescribing cardiometabolic medication. METHODS: Two focus groups were conducted among patients ≥70 years with polypharmacy, including cardiometabolic medication. Purposive sampling through four community pharmacies was used in two regions in the Netherlands. A topic list was developed using literature and the theoretical domains framework (TDF). The meetings were audio recorded, transcribed verbatim and coded using thematic coding, attribute coding and the TDF. In addition, patients were categorized on attitudes towards medication and willingness to stop. RESULTS: The meetings were attended by 17 patients and 1 caregiver (71 to 84 years). In total 15 barriers and 13 enablers were identified within four themes, partly related to beliefs, fears and experiences regarding using or stopping medication, and partly related to the relationship with the health care professional and the conditions to stop. Some patients attributed their wellbeing to their medication and were therefore unwilling to stop. Reducing cardiometabolic medication because of less strict treatment targets confused some patients and was a barrier to deprescribing. Having options to monitor clinical measurements and restart medication were enablers. Patients were only willing to stop cardiometabolic medication when this was proposed by a HCP they trusted. Patients with a positive attitude towards medication varied in their willingness to stop cardiometabolic medication. Patients with a negative attitude towards medication were generally willing to stop medication but still perceived several barriers and may consider some medication as being essential. CONCLUSION: Fears, beliefs, and experiences regarding using and stopping medication as well as trust in the HCP influence willingness to have medication deprescribed. Attitudes towards medication in general do not necessarily translate into willingness or unwillingness to stop specific medication. For deprescribing cardiometabolic medication, patient involvement when setting new treatment targets and monitoring the effects on short-term outcomes are important. Frontiers Media S.A. 2020-08-20 /pmc/articles/PMC7468428/ /pubmed/32973509 http://dx.doi.org/10.3389/fphar.2020.01268 Text en Copyright © 2020 Crutzen, Baas, Abou, van den Born-Bondt, Hugtenburg, Bouvy, Heringa, Taxis and Denig http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pharmacology Crutzen, Stijn Baas, Gert Abou, Jamila van den Born-Bondt, Tessa Hugtenburg, Jacqueline G. Bouvy, Marcel L. Heringa, Mette Taxis, Katja Denig, Petra Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study |
title | Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study |
title_full | Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study |
title_fullStr | Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study |
title_full_unstemmed | Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study |
title_short | Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study |
title_sort | barriers and enablers of older patients to deprescribing of cardiometabolic medication: a focus group study |
topic | Pharmacology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468428/ https://www.ncbi.nlm.nih.gov/pubmed/32973509 http://dx.doi.org/10.3389/fphar.2020.01268 |
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