Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Crutzen, Stijn, Baas, Gert, Abou, Jamila, van den Born-Bondt, Tessa, Hugtenburg, Jacqueline G., Bouvy, Marcel L., Heringa, Mette, Taxis, Katja, Denig, Petra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
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
_version_ 1783578215771537408
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
work_keys_str_mv AT crutzenstijn barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT baasgert barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT aboujamila barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT vandenbornbondttessa barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT hugtenburgjacquelineg barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT bouvymarcell barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT heringamette barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT taxiskatja barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy
AT denigpetra barriersandenablersofolderpatientstodeprescribingofcardiometabolicmedicationafocusgroupstudy