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Article Dans Une Revue BMC Geriatrics Année : 2021

General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

1 UNIBE - Universität Bern / University of Bern
2 University of Ioannina
3 UKIM - Ss. Cyril and Methodius University in Skopje
4 Universität Bonn = University of Bonn
5 Keele University [Keele]
6 ICGP - Irish College of General Practitioners [Dublin, Irlande]
7 Hospital Israelita Albert Einstein [São Paulo, Brazil]
8 Wrocław Medical University
9 Skane University Hospital [Lund]
10 RSFM - Romanian Society of Family Medicine [Bucharest]
11 Linnaeus University
12 MHH - Medizinische Hochschule Hannover = Hannover Medical School
13 DCGP - Danish College of General Practitioners [Copenhagen]
14 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
15 Medizinische Universität Wien = Medical University of Vienna
16 UA - University of Antwerp
17 University of Tartu
18 University of Ljubljana
19 Leipzig University / Universität Leipzig
20 SSLMG - Societé Scientifique Luxembourgois en Medicine generale [Luxembourg City]
21 LUMC - Leiden University Medical Center
22 Semmelweis University of Medicine [Budapest]
23 University of Hradec Králové
24 TAU - Tel Aviv University
25 Medical University of Plovdiv
26 University of Luxembourg [Luxembourg]
27 NMS - NOVA Medical School - Faculdade de Ciências Médicas
28 HEGP - Hôpital Européen Georges Pompidou [APHP]
29 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
30 HeKA - Health data- and model- driven Knowledge Acquisition
31 Univerzitet u Tuzli [Tuzla, Bosnie-Herzégovine]
32 RSU - Riga Stradins University
33 Tampere University Hospital
34 Dom zdravlja Zagreb - Centar [Zagreb]
35 SNMAPE - Shupyk National Medical Academy of Postgraduate Education [Kiev]
36 Dalhousie University [Halifax]
Liina Pilv
  • Fonction : Auteur
Sven Streit

Résumé

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.

Dates et versions

hal-03738911 , version 1 (26-07-2022)

Identifiants

Citer

Katharina Tabea Jungo, Sophie Mantelli, Zsofia Rozsnyai, Aristea Missiou, Biljana Gerasimovska Kitanovska, et al.. General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatrics, 2021, 21 (1), pp.19. ⟨10.1186/s12877-020-01953-6⟩. ⟨hal-03738911⟩
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