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

Katharina Jungo 1 Sophie Mantelli 1 Zsofia Rozsnyai 1 Aristea Missiou 2 Biljana Kitanovska 3 Birgitta Weltermann 4, 5 Christian Mallen 6 Claire Collins 7 Daiana Bonfim 8 Donata Kurpas 9 Ferdinando Petrazzuoli 10 Gindrovel Dumitra 11 Hans Thulesius 10, 12 Heidrun Lingner 13 Kasper Johansen 14 Katharine Wallis 15 Kathryn Hoffmann 16 Lieve Peremans 17 Liina Pilv 18 Marija Šter 19 Markus Bleckwenn 20 Martin Sattler 21 Milly van der Ploeg 22 Péter Torzsa 23 Petra Kánská 24 Shlomo Vinker 25 Radost Assenova 26 Raquel Bravo 27 Rita Viegas 28 Rosy Tsopra 29, 30, 31 Sanda Pestic 32 Sandra Gintere 33 Tuomas Koskela 34 Vanja Lazic 35 Victoria Tkachenko 36 Emily Reeve 37, 38 Clare Luymes 22 Rosalinde Poortvliet 22 Nicolas Rodondi 1, 22 Jacobijn Gussekloo 22 Sven Streit 1
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.
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Submitted on : Monday, August 2, 2021 - 10:23:11 AM
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Katharina Jungo, Sophie Mantelli, Zsofia Rozsnyai, Aristea Missiou, Biljana Kitanovska, et al.. General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatrics, BioMed Central, 2021, 21 (1), pp.19. ⟨10.1186/s12877-020-01953-6⟩. ⟨inserm-03311947⟩

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