Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial
Objective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) change in the appropriateness of medications and (3) implementation of prescribing recommendations generated by the electronic decision suppor...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-01-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/1/e075325.full |
| _version_ | 1797295784832532480 |
|---|---|
| author | Katharina Tabea Jungo Sven Streit Kristie Rebecca Weir Damien Cateau |
| author_facet | Katharina Tabea Jungo Sven Streit Kristie Rebecca Weir Damien Cateau |
| author_sort | Katharina Tabea Jungo |
| collection | DOAJ |
| description | Objective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) change in the appropriateness of medications and (3) implementation of prescribing recommendations generated by the electronic decision support system tested in the ‘Optimising PharmacoTherapy In the Multimorbid Elderly in Primary CAre’ (OPTICA) trial.Design A longitudinal sub-study of the OPTICA trial, a cluster randomised controlled trial.Setting Swiss primary care settings.Participants Participants were aged ≥65 years, with ≥3 chronic conditions and ≥5 regular medications recruited from 43 general practitioner (GP) practices.Exposures Patients’ willingness to have medications deprescribed was assessed using three questions from the ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire and its concerns about stopping score.Measures/analyses Medication-related outcomes were collected at 1 year follow-up. Aim 1 outcome: change in the number of long-term medications between baseline and 12 month follow-up. Aim 2 outcome: change in medication appropriateness (Medication Appropriateness Index). Aim 3 outcome: binary variable on whether any prescribing recommendation generated during the OPTICA medication review was implemented. We used multilevel linear regression analyses (aim 1 and aim 2) and multilevel logistic regression analyses (aim 3). Models were adjusted for sociodemographic variables and the clustering effect at GP level.Results 298 patients completed the rPATD, 45% were women and 78 years was the median age. A statistically significant association was found between the concerns about stopping score and the change in the number of medications over time (per 1-unit increase in the score the average number of medications use was 0.65 higher; 95% CI: 0.08 to 1.22). Other than that we did not find evidence for statistically significant associations between patients’ agreement with deprescribing and medication-related outcomes.Conclusions We did not find evidence for an association between most measures of patient agreement with deprescribing and medication-related outcomes over 1 year.Trial registration number NCT03724539. |
| first_indexed | 2024-03-07T21:53:57Z |
| format | Article |
| id | doaj.art-1a31f53481f54af9a96d87af4931cef0 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-07T21:53:57Z |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-1a31f53481f54af9a96d87af4931cef02024-02-24T23:05:08ZengBMJ Publishing GroupBMJ Open2044-60552024-01-0114110.1136/bmjopen-2023-075325Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trialKatharina Tabea Jungo0Sven Streit1Kristie Rebecca Weir2Damien Cateau3Institute of Primary Health Care BIHAM, University of Bern, Bern, SwitzerlandInstitute of Primary Health Care BIHAM, University of Bern, Bern, SwitzerlandInstitute of Primary Health Care BIHAM, University of Bern, Bern, SwitzerlandCommunity Pharmacy, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, SwitzerlandObjective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) change in the appropriateness of medications and (3) implementation of prescribing recommendations generated by the electronic decision support system tested in the ‘Optimising PharmacoTherapy In the Multimorbid Elderly in Primary CAre’ (OPTICA) trial.Design A longitudinal sub-study of the OPTICA trial, a cluster randomised controlled trial.Setting Swiss primary care settings.Participants Participants were aged ≥65 years, with ≥3 chronic conditions and ≥5 regular medications recruited from 43 general practitioner (GP) practices.Exposures Patients’ willingness to have medications deprescribed was assessed using three questions from the ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire and its concerns about stopping score.Measures/analyses Medication-related outcomes were collected at 1 year follow-up. Aim 1 outcome: change in the number of long-term medications between baseline and 12 month follow-up. Aim 2 outcome: change in medication appropriateness (Medication Appropriateness Index). Aim 3 outcome: binary variable on whether any prescribing recommendation generated during the OPTICA medication review was implemented. We used multilevel linear regression analyses (aim 1 and aim 2) and multilevel logistic regression analyses (aim 3). Models were adjusted for sociodemographic variables and the clustering effect at GP level.Results 298 patients completed the rPATD, 45% were women and 78 years was the median age. A statistically significant association was found between the concerns about stopping score and the change in the number of medications over time (per 1-unit increase in the score the average number of medications use was 0.65 higher; 95% CI: 0.08 to 1.22). Other than that we did not find evidence for statistically significant associations between patients’ agreement with deprescribing and medication-related outcomes.Conclusions We did not find evidence for an association between most measures of patient agreement with deprescribing and medication-related outcomes over 1 year.Trial registration number NCT03724539.https://bmjopen.bmj.com/content/14/1/e075325.full |
| spellingShingle | Katharina Tabea Jungo Sven Streit Kristie Rebecca Weir Damien Cateau Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial BMJ Open |
| title | Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial |
| title_full | Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial |
| title_fullStr | Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial |
| title_full_unstemmed | Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial |
| title_short | Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial |
| title_sort | older adults attitudes towards deprescribing and medication changes a longitudinal sub study of a cluster randomised controlled trial |
| url | https://bmjopen.bmj.com/content/14/1/e075325.full |
| work_keys_str_mv | AT katharinatabeajungo olderadultsattitudestowardsdeprescribingandmedicationchangesalongitudinalsubstudyofaclusterrandomisedcontrolledtrial AT svenstreit olderadultsattitudestowardsdeprescribingandmedicationchangesalongitudinalsubstudyofaclusterrandomisedcontrolledtrial AT kristierebeccaweir olderadultsattitudestowardsdeprescribingandmedicationchangesalongitudinalsubstudyofaclusterrandomisedcontrolledtrial AT damiencateau olderadultsattitudestowardsdeprescribingandmedicationchangesalongitudinalsubstudyofaclusterrandomisedcontrolledtrial |