BMC Geriatrics (Jan 2021)
General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries
- 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
Affiliations
- Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern
- Sophie Mantelli
- Institute of Primary Health Care (BIHAM), University of Bern
- Zsofia Rozsnyai
- Institute of Primary Health Care (BIHAM), University of Bern
- Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina
- Biljana Gerasimovska Kitanovska
- Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius
- Birgitta Weltermann
- Institute for General Practice, University of Duisburg-Essen, University Hospital Essen
- Christian Mallen
- Primary, Community and Social Care, Keele University
- Claire Collins
- Irish College of General Practitioners
- Daiana Bonfim
- Hospital Israelita Albert Einstein
- Donata Kurpas
- Family Medicine Department, Wroclaw Medical University
- Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University
- Gindrovel Dumitra
- Romanian Society of Family Medicine
- Hans Thulesius
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University
- Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare
- Kasper Lorenz Johansen
- Danish College of General Practitioners
- Katharine Wallis
- Primary Care Clinical Unit, the University of Queensland
- Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna
- Lieve Peremans
- Department of Primary and Interdisciplinary Care, University Antwerp
- Liina Pilv
- Department of Family Medicine, University of Tartu
- Marija Petek Šter
- Department of Family Medicine, Medical Faculty, University of Ljubljana
- Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, University of Leipzig
- Martin Sattler
- SSLMG, Societé Scientifique Luxembourgois en Medicine generale
- Milly van der Ploeg
- Department of Public Health and Primary Care, Leiden University Medical Center
- Péter Torzsa
- Department of Family Medicine, Semmelweis University
- Petra Bomberová Kánská
- Department of Social Medicine, Charles University, Faculty of Medicine in Hradec Kralove
- Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University
- Radost Assenova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv
- Raquel Gomez Bravo
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg
- Rita P. A. Viegas
- Family Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical School
- Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine
- Sanda Kreitmayer Pestic
- Family Medicine Department, Medical School, University of Tuzla
- Sandra Gintere
- Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University
- Tuomas H. Koskela
- Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University
- Vanja Lazic
- Dom zdravlja Zagreb - Centar
- Victoria Tkachenko
- Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education
- Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia
- Clare Luymes
- Department of Public Health and Primary Care, Leiden University Medical Center
- Rosalinde K. E. Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center
- Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern
- Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center
- Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern
- DOI
- https://doi.org/10.1186/s12877-020-01953-6
- Journal volume & issue
-
Vol. 21,
no. 1
pp. 1 – 12
Abstract
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.
Keywords
