Understanding older patients' willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries.
Deprescribing; Older adults; Polypharmacy; Primary care; Survey study; Humans; Aged; Cross-Sectional Studies; Europe/epidemiology; Switzerland; Surveys and Questionnaires; Primary Health Care; Europe; Geriatrics and Gerontology
Abstract :
[en] ("[en] INTRODUCTION: To reduce inappropriate polypharmacy, deprescribing should be part of patients' regular care. Yet deprescribing is difficult to implement, as shown in several studies. Understanding patients' attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults' perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients' willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions.
METHODS AND ANALYSIS: This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (n = 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients' medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements.
DISCUSSION: The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients' preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs' and patients' views and preferences on stopping or reducing specific medications. Our findings will help to understand patients' attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients' preferences.","[en] ","")
Disciplines :
Geriatrics
Author, co-author :
Lüthold, Renata Vidonscky; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland ; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
Jungo, Katharina Tabea; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
Weir, Kristie Rebecca; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland ; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Geier, Anne-Kathrin; Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
Scholtes, Béatrice ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale
Kurpas, Donata; Family Medicine Department, Wrocław Medical University, Wrocław, Poland
Wild, Dorothea M G; Institute of Family Medicine and General Practice, University Hospital Bonn, Bonn University, Bonn, Germany
Petrazzuoli, Ferdinando; Sezione SNaMID Caserta, Caserta, Italy ; Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
Thulesius, Hans; Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden ; Department of Clinical Sciences, Lund University, Malmö, Sweden
Lingner, Heidrun; Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
Assenova, Radost; Department of Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
Poortvliet, Rosalinde K E; University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands ; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Lazic, Vanja; Health center Zagreb - Centar, Zagreb, Croatia
Rozsnyai, Zsofia; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
Streit, Sven ; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland. sven.streit@biham.unibe.ch
Understanding older patients' willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries.
This work is financially supported by the Kollegium für Hausarztmedizin (KHM) through a research grant given to ZR.We thank Birgitta Weltermann, Jacobijn Gussekloo, Markus Bleckwenn and Thomas Frese for their support with the conduct of this study and their editorial suggestions. Katharina Tabea Jungo is a member of the Junior Investigator Intensive Program of the US Deprescribing Research Network, which is funded by the National Institute on Aging (R24AG064025).
Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–95.
Midão L, Giardini A, Menditto E, Kardas P, Costa E. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr. 2018;78:213–20.
Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314(17):1818–30.
Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010. BMC Med. 2015;13(1):1–10. DOI: 10.1186/s12916-015-0322-7
de Godoi Rezende Costa Molino C, Chocano-Bedoya PO, Sadlon A, Theiler R, Orav JE, Vellas B, et al. Prevalence of polypharmacy in community-dwelling older adults from seven centres in five European countries: a cross-sectional study of DO-HEALTH. BMJ Open 2022;12(4):e051881.
Aubert CE, Streit S, Da Costa BR, Collet T-H, Cornuz J, Gaspoz J-M, et al. Polypharmacy and specific comorbidities in university primary care settings. Eur J Intern Med. 2016;35:35–42.
Fletcher PC, Berg K, Dalby DM, Hirdes JP. Risk factors for falling among community-based seniors. J Patient Safety. 2009:61–6.
Milton JC, Hill-Smith I, Jackson SH. Prescribing for older people. BMJ. 2008;336(7644):606–9.
Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf. 2011;20(5):514–22.
Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Di Muzio M, et al. Potentially inappropriate medications and functional decline in elderly hospitalized patients. J Am Geriatr Soc. 2009;57(6):1007–14.
Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother. 2004;38(2):303–12.
Fincke BG, Miller DR, Spiro A 3rd. The interaction of patient perception of overmedication with drug compliance and side effects. J Gen Intern Med. 1998;13(3):182–5.
Blozik E, Rapold R, von Overbeck J, Reich O. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs Aging. 2013;30(7):561–8.
Guaraldo L, Cano FG, Damasceno GS, Rozenfeld S. Inappropriate medication use among the elderly: a systematic review of administrative databases. BMC Geriatr. 2011;11(1):79.
Jungo KT, Streit S, Lauffenburger JC. Utilization and spending on potentially inappropriate medications by US older adults with multiple chronic conditions using multiple medications. Arch Gerontol Geriatr. 2021;93:104326.
Panel AGSBCUE, Fick DM, Semla TP, Steinman M, Beizer J, Brandt N, et al. American Geriatrics Society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–94.
Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14.
Motter FR, Fritzen JS, Hilmer SN, Paniz ÉV, Paniz VMV. Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol. 2018;74(6):679–700.
Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of ‘deprescribing’with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254–68.
Moriarty F, Hardy C, Bennett K, Smith SM, Fahey T. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study. BMJ Open. 2015;5(9):e008656.
Todd A, Holmes HM. Recommendations to support deprescribing medications late in life. Int J Clin Pharm. 2015;37(5):678–81.
Lindsay J, Dooley M, Martin J, Fay M, Kearney A, Barras M. Reducing potentially inappropriate medications in palliative cancer patients: evidence to support deprescribing approaches. Support Care Cancer. 2014;22(4):1113–9.
Burge F, Lawson B, Mitchell G. How to move to a palliative approach to care for people with multimorbidity. BMJ. 2012;345:e6324.
Barnett N, Jubraj B. A themed journal issue on deprescribing. Eur J Hosp Pharm. 2017;24(1):1–2.
Rozsnyai Z, Jungo KT, Reeve E, Poortvliet RKE, Rodondi N, Gussekloo J, et al. What do older adults with multimorbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey. BMC Geriatr. 2020;20(1):435.
Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793–807.
Heath I. Role of fear in overdiagnosis and overtreatment--an essay by Iona Heath. BMJ 2014;349:g6123.
Weir K, Nickel B, Naganathan V, Bonner C, McCaffery K, Carter SM, et al. Decision-making preferences and Deprescribing: perspectives of older adults and companions about their medicines. J Gerontol B Psychol Sci Soc Sci. 2018;73(7):e98–e107.
Weir KR, Ailabouni NJ, Schneider CR, Hilmer SN, Reeve E. Consumer attitudes towards deprescribing: a systematic review and meta-analysis. The Journals of Gerontology: Series A. 2021.
Jungo KT, Meier R, Valeri F, Schwab N, Schneider C, Reeve E, et al. Baseline characteristics and comparability of older multimorbid patients with polypharmacy and general practitioners participating in a randomized controlled primary care trial. BMC Fam Pract. 2021;22(1):123.
Lau DT, Briesacher BA, Mercaldo ND, Halpern L, Osterberg EC, Jarzebowski M, et al. Older patients’ perceptions of medication importance and worth. Drugs Aging. 2008;25(12):1061–75.
Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, et al. Too much medicine in older people? BMJ. 2016;353:i2893.
Frankowski N, Grootens KP, van der Stelt CA, Noort A, van Marum RJ. 'You tell me, you are the doctor'; patients on long-term psychiatric residences about their medication. Tijdschrift voor psychiatrie. 2019;61(8):527–35.
Coran JJ, Koropeckyj-Cox T, Arnold CL. Are physicians and patients in agreement? Exploring dyadic concordance. Health Educ Behav. 2013;40(5):603–11.
Marques-Vidal P, Pecoud A, Hayoz D, Paccaud F, Mooser V, Waeber G, et al. Prevalence and characteristics of vitamin or dietary supplement users in Lausanne, Switzerland: the CoLaus study. Eur J Clin Nutr. 2009;63(2):273–81.
Troxler DS, Michaud PA, Graz B, Rodondi PY. Exploratory survey about dietary supplement use: a hazardous and erratic way to improve one's health? Swiss Med Wkly. 2013;143:w13807.
Werner SM. Patient safety and the widespread use of herbs and supplements. Front Pharmacol. 2014:5.
Agbabiaka TB, Spencer NH, Khanom S, Goodman C. Prevalence of drug-herb and drug-supplement interactions in older adults: a cross-sectional survey. Br J Gen Pract. 2018;68(675):e711–e7.
Pitkala KH, Suominen MH, Bell JS, Strandberg TE. Herbal medications and other dietary supplements. A clinical review for physicians caring for older people. Ann Med. 2016;48(8):586–602.
Paque K, Elseviers M, Vander Stichele R, Dilles T, Pardon K, Deliens L, et al. Associations of potentially inappropriate medication use with four year survival of an inception cohort of nursing home residents. Arch Gerontol Geriatr. 2019;80:82–7.
Lavan AH, Gallagher P, Parsons C, O'Mahony D. STOPPFrail (screening tool of older persons prescriptions in frail adults with limited life expectancy): consensus validation. Age Ageing. 2017;46(4):600–7.
American Geriatrics Society updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.
Jungo KT, Mantelli S, Rozsnyai Z, Missiou A, Kitanovska BG, Weltermann B, et al. General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatr. 2021;21(1):19.
Boels AM, Koning E, Vos RC, Khunti K, Rutten GE. Individualised targets for insulin initiation in type 2 diabetes mellitus-the influence of physician and practice: a cross-sectional study in eight European countries. BMJ Open. 2019;9(8):e032040.
Streit S, Gussekloo J, Burman RA, Collins C, Kitanovska BG, Gintere S, et al. Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old. Scand J Prim Health Care. 2018;36(1):89–98.
Weir KR, Naganathan V, Carter SM, Tam CWM, McCaffery K, Bonner C, et al. The role of older patients' goals in GP decision-making about medicines: a qualitative study. BMC Fam Pract. 2021;22(1):13.
Reeve E, Low LF, Shakib S, Hilmer SN. Development and validation of the revised Patients' attitudes towards Deprescribing (rPATD) questionnaire: versions for older adults and caregivers. Drugs Aging. 2016;33(12):913–28.
Dugan E, Trachtenberg F, Hall MA. Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Serv Res. 2005;5:64.
Driever EM, Stiggelbout AM, Brand PLP. Shared decision making: Physicians' preferred role, usual role and their perception of its key components. Patient Educ Couns. 2020;103(1):77–82.
Patridge EF, Bardyn TP. Research electronic data capture (REDCap). JMLA. 2018;106(1):142.
Garcia KKS, Abrahão AA. Research development using REDCap software. Healthc Inform Res. 2021;27(4):341–9.
Smeeth L, Ng ES. Intraclass correlation coefficients for cluster randomized trials in primary care: data from the MRC trial of the assessment and Management of Older People in the community. Control Clin Trials. 2002;23(4):409–21.
Jungo K, Lindemann F, Schwab N, Streit S. Hürden und Chancen der klinischen Forschung in der Hausarztmedizin. Primary and Hospital Care: Allgemeine Innere Medizin. 2019.
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