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 (2018). How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study. BMC family practice, 19(1), p. 169. BioMed Central 10.1186/s12875-018-0856-9

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Mantelli, Sophie; Jungo, Katharina Tabea; Rozsnyai, Zsófia; Chiolero, Arnaud; Rodondi, Nicolas and Streit, Sven

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1471-2296

Publisher:

BioMed Central

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

16 Oct 2018 15:07

Last Modified:

19 Dec 2018 10:37

Publisher DOI:

10.1186/s12875-018-0856-9

PubMed ID:

30314468

Uncontrolled Keywords:

Complexity Deprescribing Frailty Multimorbidity Old age Polypharmacy

BORIS DOI:

10.7892/boris.120498

URI:

https://boris.unibe.ch/id/eprint/120498

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