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 (2020). What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey. BMC Geriatrics, 20(1), p. 435. BioMed Central 10.1186/s12877-020-01843-x

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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.

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:

Rozsnyai, Zsófia; Jungo, Katharina Tabea; Rodondi, Nicolas and Streit, Sven

Subjects:

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

ISSN:

1471-2318

Publisher:

BioMed Central

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

04 Nov 2020 11:46

Last Modified:

04 Nov 2020 11:46

Publisher DOI:

10.1186/s12877-020-01843-x

PubMed ID:

33129274

Uncontrolled Keywords:

Deprescribing General practice Multimorbidity Older adults Patient attitudes Polypharmacy

BORIS DOI:

10.7892/boris.147763

URI:

https://boris.unibe.ch/id/eprint/147763

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