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What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey
BACKGROUND: Multimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe give...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602330/ https://www.ncbi.nlm.nih.gov/pubmed/33129274 http://dx.doi.org/10.1186/s12877-020-01843-x |
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author | Rozsnyai, Zsofia Jungo, Katharina Tabea Reeve, Emily Poortvliet, Rosalinde K. E. Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven |
author_facet | Rozsnyai, Zsofia Jungo, Katharina Tabea Reeve, Emily Poortvliet, Rosalinde K. E. Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven |
author_sort | Rozsnyai, Zsofia |
collection | PubMed |
description | BACKGROUND: Multimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe given time constraints and few recommendations from guidelines. Further, patient related barriers and enablers to deprescribing have to be accounted for. The aim of this study was to identify barriers and enablers to deprescribing as reported by older adults with polypharmacy and multimorbidity. METHODS: We conducted a survey among participants aged ≥70 years, with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 chronic medications). We invited Swiss GPs, to recruit eligible patients who then completed a paper-based survey on demographics, medications and chronic conditions. We used the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire and added twelve additional Likert scale questions and two open-ended questions to assess barriers and enablers towards deprescribing, which we coded and categorized into meaningful themes. RESULT: Sixty four Swiss GPs consented to recruit 5–6 patients each and returned 300 participant responses. Participants were 79.1 years (SD 5.7), 47% female, 34% lived alone, and 86% managed their medications themselves. Sixty-seven percent of participants took 5–9 regular medicines and 24% took ≥10 medicines. The majority of participants (77%) were willing to deprescribe one or more of their medicines if their doctor said it was possible. There was no association with sex, age or the number of medicines and willingness to deprescribe. After adjustment for baseline characteristics, there was a strong positive association between willingness to deprescribe and saying that because they have a good relationship with their GP, they would feel that deprescribing was safe OR 11.3 (95% CI: 4.64–27.3) and agreeing that they would be willing to deprescribe if new studies showed an avoidable risk OR 8.0 (95% CI 3.79–16.9). From the open questions, the most mentioned barriers towards deprescribing were patients feeling well on their current medicines and being convinced that they need all their medicines. CONCLUSIONS: Most older adults with polypharmacy are willing to deprescribe. GPs may be able to increase deprescribing by building trust with their patients and communicating evidence about the risks of medication use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-020-01843-x. |
format | Online Article Text |
id | pubmed-7602330 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-76023302020-11-02 What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey Rozsnyai, Zsofia Jungo, Katharina Tabea Reeve, Emily Poortvliet, Rosalinde K. E. Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven BMC Geriatr Research Article BACKGROUND: Multimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe given time constraints and few recommendations from guidelines. Further, patient related barriers and enablers to deprescribing have to be accounted for. The aim of this study was to identify barriers and enablers to deprescribing as reported by older adults with polypharmacy and multimorbidity. METHODS: We conducted a survey among participants aged ≥70 years, with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 chronic medications). We invited Swiss GPs, to recruit eligible patients who then completed a paper-based survey on demographics, medications and chronic conditions. We used the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire and added twelve additional Likert scale questions and two open-ended questions to assess barriers and enablers towards deprescribing, which we coded and categorized into meaningful themes. RESULT: Sixty four Swiss GPs consented to recruit 5–6 patients each and returned 300 participant responses. Participants were 79.1 years (SD 5.7), 47% female, 34% lived alone, and 86% managed their medications themselves. Sixty-seven percent of participants took 5–9 regular medicines and 24% took ≥10 medicines. The majority of participants (77%) were willing to deprescribe one or more of their medicines if their doctor said it was possible. There was no association with sex, age or the number of medicines and willingness to deprescribe. After adjustment for baseline characteristics, there was a strong positive association between willingness to deprescribe and saying that because they have a good relationship with their GP, they would feel that deprescribing was safe OR 11.3 (95% CI: 4.64–27.3) and agreeing that they would be willing to deprescribe if new studies showed an avoidable risk OR 8.0 (95% CI 3.79–16.9). From the open questions, the most mentioned barriers towards deprescribing were patients feeling well on their current medicines and being convinced that they need all their medicines. CONCLUSIONS: Most older adults with polypharmacy are willing to deprescribe. GPs may be able to increase deprescribing by building trust with their patients and communicating evidence about the risks of medication use. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-020-01843-x. BioMed Central 2020-10-31 /pmc/articles/PMC7602330/ /pubmed/33129274 http://dx.doi.org/10.1186/s12877-020-01843-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data. |
spellingShingle | Research Article Rozsnyai, Zsofia Jungo, Katharina Tabea Reeve, Emily Poortvliet, Rosalinde K. E. Rodondi, Nicolas Gussekloo, Jacobijn Streit, Sven What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey |
title | What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey |
title_full | What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey |
title_fullStr | What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey |
title_full_unstemmed | What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey |
title_short | What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey |
title_sort | what do older adults with multimorbidity and polypharmacy think about deprescribing? the less study - a primary care-based survey |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602330/ https://www.ncbi.nlm.nih.gov/pubmed/33129274 http://dx.doi.org/10.1186/s12877-020-01843-x |
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