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

Research output: Contribution to journalArticle

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.

Details

Authors
  • Katharina Tabea Jungo
  • Sophie Mantelli
  • Zsofia Rozsnyai
  • Aristea Missiou
  • Biljana Gerasimovska Kitanovska
  • Birgitta Weltermann
  • Christian Mallen
  • Claire Collins
  • Daiana Bonfim
  • Donata Kurpas
  • Gindrovel Dumitra
  • 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
Organisations
External organisations
  • University of Bern
  • University of Ioannina
  • University Hospital Essen
  • University of Bonn
  • Keele University
  • Irish College of General Practitioners
  • Albert Einstein Israelite Hospital
  • Wrocław Medical University
  • Linnaeus University
  • Hannover Medical School
  • Danish College of General Practitioners
  • University of Queensland
  • Medical University of Vienna
  • University of Antwerp
  • University of Tartu
  • University of Ljubljana
  • Leipzig University
  • Société Scientifique Luxembourgeoise de Médecine Générale (SSLMG)
  • Leiden University Medical Centre
  • Semmelweis University
  • Charles University in Prague
  • Tel-Aviv University
  • Medical University of Plovdiv
  • University of Luxembourg
  • New University of Lisbon
  • Hôpital Européen Georges-Pompidou
  • University of Tuzla
  • Riga Stradins University
  • University of Tampere
  • University Hospital of Infectious Diseases
  • Shupyk National Medical Academy of Postgraduate Education
  • University of South Australia
  • Dalhousie University
  • UWV (Employee Insurance Agency)
  • Bern University Hospital
  • The Saints Cyril and Methodius University of Skopje
  • Romanian National Society of Family Medicine
  • Paris-Sorbonne University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Geriatrics
  • Pharmacology and Toxicology

Keywords

  • Deprescribing, Multimorbidity, Old age, Polypharmacy, Primary health care
Original languageEnglish
Article number19
JournalBMC Geriatrics
Volume21
Issue number1
Publication statusPublished - 2021
Publication categoryResearch
Peer-reviewedYes