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; Kurpas, Donata; Petrazzuoli, Ferdinando; Dumitra, Gindrovel; Thulesius, Hans; Lingner, Heidrun; Johansen, Kasper Lorenz; Wallis, Katharine; Hoffmann, Kathryn; Peremans, Lieve; Pilv, Liina; Šter, Marija Petek; ... (2021). General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatrics, 21(1), p. 19. BioMed Central 10.1186/s12877-020-01953-6

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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.

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:

Jungo, Katharina Tabea; Mantelli, Sophie; Rozsnyai, Zsófia; 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:

Doris Kopp Heim

Date Deposited:

13 Jan 2021 12:05

Last Modified:

13 Mar 2021 20:18

Publisher DOI:

10.1186/s12877-020-01953-6

PubMed ID:

33413142

Uncontrolled Keywords:

Deprescribing Multimorbidity Old age Polypharmacy Primary health care

BORIS DOI:

10.48350/151228

URI:

https://boris.unibe.ch/id/eprint/151228

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