General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries
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...
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-020-01953-6 |
| _version_ | 1818953232950493184 |
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| author | Katharina Tabea Jungo Sophie Mantelli Zsofia Rozsnyai Aristea Missiou Biljana Gerasimovska Kitanovska Birgitta Weltermann Christian Mallen Claire Collins Daiana Bonfim Donata Kurpas Ferdinando Petrazzuoli Gindrovel Dumitra Hans Thulesius Heidrun Lingner Kasper Lorenz Johansen Katharine Wallis Kathryn Hoffmann Lieve Peremans Liina Pilv Marija Petek Šter Markus Bleckwenn Martin Sattler Milly van der Ploeg Péter Torzsa Petra Bomberová Kánská Shlomo Vinker Radost Assenova Raquel Gomez Bravo Rita P. A. Viegas Rosy Tsopra Sanda Kreitmayer Pestic Sandra Gintere Tuomas H. Koskela Vanja Lazic Victoria Tkachenko Emily Reeve Clare Luymes Rosalinde K. E. Poortvliet Nicolas Rodondi Jacobijn Gussekloo Sven Streit |
| author_facet | Katharina Tabea Jungo Sophie Mantelli Zsofia Rozsnyai Aristea Missiou Biljana Gerasimovska Kitanovska Birgitta Weltermann Christian Mallen Claire Collins Daiana Bonfim Donata Kurpas Ferdinando Petrazzuoli Gindrovel Dumitra Hans Thulesius Heidrun Lingner Kasper Lorenz Johansen Katharine Wallis Kathryn Hoffmann Lieve Peremans Liina Pilv Marija Petek Šter Markus Bleckwenn Martin Sattler Milly van der Ploeg Péter Torzsa Petra Bomberová Kánská Shlomo Vinker Radost Assenova Raquel Gomez Bravo Rita P. A. Viegas Rosy Tsopra Sanda Kreitmayer Pestic Sandra Gintere Tuomas H. Koskela Vanja Lazic Victoria Tkachenko Emily Reeve Clare Luymes Rosalinde K. E. Poortvliet Nicolas Rodondi Jacobijn Gussekloo Sven Streit |
| author_sort | Katharina Tabea Jungo |
| collection | DOAJ |
| description | 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 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. |
| first_indexed | 2024-12-20T10:03:00Z |
| format | Article |
| id | doaj.art-88b4ce45f6e74149a5c46d1931604ec4 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-20T10:03:00Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-88b4ce45f6e74149a5c46d1931604ec42022-12-21T19:44:18ZengBMCBMC Geriatrics1471-23182021-01-0121111210.1186/s12877-020-01953-6General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countriesKatharina Tabea Jungo0Sophie Mantelli1Zsofia Rozsnyai2Aristea Missiou3Biljana Gerasimovska Kitanovska4Birgitta Weltermann5Christian Mallen6Claire Collins7Daiana Bonfim8Donata Kurpas9Ferdinando Petrazzuoli10Gindrovel Dumitra11Hans Thulesius12Heidrun Lingner13Kasper Lorenz Johansen14Katharine Wallis15Kathryn Hoffmann16Lieve Peremans17Liina Pilv18Marija Petek Šter19Markus Bleckwenn20Martin Sattler21Milly van der Ploeg22Péter Torzsa23Petra Bomberová Kánská24Shlomo Vinker25Radost Assenova26Raquel Gomez Bravo27Rita P. A. Viegas28Rosy Tsopra29Sanda Kreitmayer Pestic30Sandra Gintere31Tuomas H. Koskela32Vanja Lazic33Victoria Tkachenko34Emily Reeve35Clare Luymes36Rosalinde K. E. Poortvliet37Nicolas Rodondi38Jacobijn Gussekloo39Sven Streit40Institute of Primary Health Care (BIHAM), University of BernInstitute of Primary Health Care (BIHAM), University of BernInstitute of Primary Health Care (BIHAM), University of BernResearch Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of IoanninaDepartment of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and MetodiusInstitute for General Practice, University of Duisburg-Essen, University Hospital EssenPrimary, Community and Social Care, Keele UniversityIrish College of General PractitionersHospital Israelita Albert EinsteinFamily Medicine Department, Wroclaw Medical UniversityDepartment of Clinical Sciences, Centre for Primary Health Care Research, Lund UniversityRomanian Society of Family MedicineDepartment of Clinical Sciences, Centre for Primary Health Care Research, Lund UniversityHannover Medical School, Center for Public Health and HealthcareDanish College of General PractitionersPrimary Care Clinical Unit, the University of QueenslandDepartment of General Practice and Family Medicine, Center for Public Health, Medical University of ViennaDepartment of Primary and Interdisciplinary Care, University AntwerpDepartment of Family Medicine, University of TartuDepartment of Family Medicine, Medical Faculty, University of LjubljanaDepartment of General Practice, Faculty of Medicine, University of LeipzigSSLMG, Societé Scientifique Luxembourgois en Medicine generaleDepartment of Public Health and Primary Care, Leiden University Medical CenterDepartment of Family Medicine, Semmelweis UniversityDepartment of Social Medicine, Charles University, Faculty of Medicine in Hradec KraloveDepartment of Family Medicine, Sackler Faculty of Medicine, Tel Aviv UniversityDepartment of Urology and General Medicine, Faculty of Medicine, Medical University of PlovdivInstitute for Health and Behaviour, Research Unit INSIDE, University of LuxembourgFamily Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical SchoolINSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized MedicineFamily Medicine Department, Medical School, University of TuzlaFaculty of Medicine, Department of Family Medicine, Riga Stradiņs UniversityClinical Medicine, Faculty of Medicine and Health Technology, Tampere UniversityDom zdravlja Zagreb - CentarDepartment of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate EducationQuality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South AustraliaDepartment of Public Health and Primary Care, Leiden University Medical CenterDepartment of Public Health and Primary Care, Leiden University Medical CenterInstitute of Primary Health Care (BIHAM), University of BernDepartment of Public Health and Primary Care, Leiden University Medical CenterInstitute of Primary Health Care (BIHAM), University of BernAbstract 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.https://doi.org/10.1186/s12877-020-01953-6DeprescribingPolypharmacyMultimorbidityPrimary health careOld age |
| spellingShingle | Katharina Tabea Jungo Sophie Mantelli Zsofia Rozsnyai Aristea Missiou Biljana Gerasimovska Kitanovska Birgitta Weltermann Christian Mallen Claire Collins Daiana Bonfim Donata Kurpas Ferdinando Petrazzuoli Gindrovel Dumitra Hans Thulesius Heidrun Lingner Kasper Lorenz Johansen Katharine Wallis Kathryn Hoffmann Lieve Peremans Liina Pilv Marija Petek Šter Markus Bleckwenn Martin Sattler Milly van der Ploeg Péter Torzsa Petra Bomberová Kánská Shlomo Vinker Radost Assenova Raquel Gomez Bravo Rita P. A. Viegas Rosy Tsopra Sanda Kreitmayer Pestic Sandra Gintere Tuomas H. Koskela Vanja Lazic Victoria Tkachenko Emily Reeve Clare Luymes Rosalinde K. E. Poortvliet Nicolas Rodondi Jacobijn Gussekloo Sven Streit General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries BMC Geriatrics Deprescribing Polypharmacy Multimorbidity Primary health care Old age |
| title | General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries |
| title_full | General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries |
| title_fullStr | General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries |
| title_full_unstemmed | General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries |
| title_short | General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries |
| title_sort | general practitioners deprescribing decisions in older adults with polypharmacy a case vignette study in 31 countries |
| topic | Deprescribing Polypharmacy Multimorbidity Primary health care Old age |
| url | https://doi.org/10.1186/s12877-020-01953-6 |
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