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General practitioners’ deprescribing decisions in older adults with polypharmacy : a case vignette study in 31 countries

Jungo, Katharina Tabea ; Mantelli, Sophie ; Rozsnyai, Zsofia ; Missiou, Aristea ; Kitanovska, Biljana Gerasimovska ; Weltermann, Birgitta ; Mallen, Christian ; Collins, Claire ; Bonfim, Daiana and Kurpas, Donata , et al. (2021) In BMC Geriatrics 21(1).
Abstract

Background: General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries. Methods: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We... (More)

Background: General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries. Methods: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions. Results: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). Interpretation: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Deprescribing, Multimorbidity, Old age, Polypharmacy, Primary health care
in
BMC Geriatrics
volume
21
issue
1
article number
19
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85098861044
  • pmid:33413142
ISSN
1471-2318
DOI
10.1186/s12877-020-01953-6
language
English
LU publication?
yes
id
0badf09b-4070-4618-81db-4d6915bd1eff
date added to LUP
2021-01-12 13:52:07
date last changed
2021-05-11 01:40:26
@article{0badf09b-4070-4618-81db-4d6915bd1eff,
  abstract     = {<p>Background: General practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients’ health. However, deprescribing can be challenging for physicians. This study investigates GPs’ deprescribing decisions in 31 countries. Methods: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs’ deprescribing decisions. Results: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (&gt; 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). Interpretation: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.</p>},
  author       = {Jungo, Katharina Tabea and Mantelli, Sophie and Rozsnyai, Zsofia and Missiou, Aristea and Kitanovska, Biljana Gerasimovska and Weltermann, Birgitta and Mallen, Christian and Collins, Claire and Bonfim, Daiana and Kurpas, Donata and Petrazzuoli, Ferdinando and Dumitra, Gindrovel and Thulesius, Hans and Lingner, Heidrun and Johansen, Kasper Lorenz and Wallis, Katharine and Hoffmann, Kathryn and Peremans, Lieve and Pilv, Liina and Šter, Marija Petek and Bleckwenn, Markus and Sattler, Martin and van der Ploeg, Milly and Torzsa, Péter and Kánská, Petra Bomberová and Vinker, Shlomo and Assenova, Radost and Bravo, Raquel Gomez and Viegas, Rita P.A. and Tsopra, Rosy and Pestic, Sanda Kreitmayer and Gintere, Sandra and Koskela, Tuomas H. and Lazic, Vanja and Tkachenko, Victoria and Reeve, Emily and Luymes, Clare and Poortvliet, Rosalinde K.E. and Rodondi, Nicolas and Gussekloo, Jacobijn and Streit, Sven},
  issn         = {1471-2318},
  language     = {eng},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Geriatrics},
  title        = {General practitioners’ deprescribing decisions in older adults with polypharmacy : a case vignette study in 31 countries},
  url          = {http://dx.doi.org/10.1186/s12877-020-01953-6},
  doi          = {10.1186/s12877-020-01953-6},
  volume       = {21},
  year         = {2021},
}