People's Attitudes, Beliefs, and Experiences Regarding Polypharmacy and Willingness to Deprescribe

Reeve, Emily; Wiese, Michael; Hendrix, Ivanka; Roberts, Michael S.; Shakib, Sepehr

doi:10.1111/jgs.12418

Cited by 185 publications

(221 citation statements)

References 42 publications

(50 reference statements)

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“…4,11 In two separate studies in Australia (one in an outpatient clinic and one in inpatients) almost 90% of older adults reported being willing to have one or more of their medications ceased. 12,13 This is in contrast to the aforementioned prescriber perceptions of patient resistance, as well as findings of several interventional deprescribing studies which suggest that patient willingness to have a medication ceased may not be this high. 14,15 A recent systematic review identified five main consumer-reported barriers and/ or enablers to deprescribing: 16 perceived appropriateness of withdrawal, process of deprescribing, influences on the consumers' decision to cease a medication, general dislike of medications, and fear associated with medication withdrawal.…”

Section: Introductioncontrasting

confidence: 49%

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Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

Reeve¹,

2016

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Section: Introductioncontrasting

confidence: 49%

“…12 However, as this card also enables patients to obtain medications at a lower price this confuses these results. In this same study, private health insurance (a marker of high socioeconomic status) was not associated with willingness to have a medication deprescribed.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

Reeve¹,

2016

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“…Twenty-four of these articles were non-systematic reviews/editorials/commentaries [1,12,, three systematic reviews [43][44][45], five original research articles [46][47][48][49][50], one letter to the editor [51], two newsletters [52,53], one master thesis [54] and one conference paper [55]. The vast majority of the articles were published by an Australian first author (n = 26, five US, two UK, two Canada, one France, one Italy).…”

Section: Resultsmentioning

confidence: 99%

“…The papers with the highest indegree were Le Couteur et al [26] (five citation ties, six common author ties) and Woodward [1] (nine citation ties, one common author tie). Reeve et al [50] was the only article to both cite and be cited. Visually, neither having a common author nor citations appeared to be responsible for use of specific characteristics within a definition and all characteristics appeared in at least two unlinked clusters.…”

Section: Network Analysismentioning

confidence: 99%

“…11 [1,23,26,28,30,35,38,40,42,44,50] '…supervised by a clinician.' [40] '…planning and communicating a cessation regimen…' [44] Describes deprescribing as involving multiple steps (STEPS) '…with the goal of managing polypharmacy and improving outcomes…' [39] Uses the term 'taper' (TAPER) 4 [39,41,44,55] '…the process of tapering…' [55] The emerging definition of 'deprescribing'…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

Reeve

Gnjidic

Long

et al. 2015

Brit J Clinical Pharma

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Aims The aim of this study was to identify what definitions have been published for the term ‘deprescribing’, and determine whether a unifying definition could be reached. A secondary aim was to uncover patterns between the published definitions which could explain any variation. Methods Systematic literature searches were performed (earliest records to February 2014) in MEDLINE, Embase, CINAHL, Informit, Scopus and Google Scholar. The terms deprescrib* or de‐prescrib* were employed as a keyword search in all fields. Conventional content analysis and word frequencies were used to identify characteristics of the definitions. Network analysis was conducted to visualize characteristic distribution across authors and articles. Results Following removal of duplicates, 231 articles were retrieved, 37 of which included a definition. Eight characteristics of the definitions were identified: use of the term stop/withdraw/cease/discontinue (35 articles), aspect of prescribing included e.g. long term therapy/inappropriate medications (n = 18), use of the term ‘process’ or ‘structured’ (n = 13), withdrawal is planned/supervised/judicious (n = 11), involving multiple steps (n = 7), includes dose reduction/substitution (n = 7), desired goals/outcomes described (n = 5) and involves tapering (n = 4). Network analysis did not reveal patterns responsible for variations in previously used definitions. Conclusions These findings show that there is lack of consensus on the definition of deprescribing. This article proposes the following definition: ‘Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’. This definition has not yet been externally validated and further work is required to develop an internationally accepted and appropriate definition.

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Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

et al. 2018

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and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance to discontinuing medication use is a significant barrier to deprescribing. OBJECTIVE To describe the attitudes of older adults toward deprescribing and to determine whether individual characteristics are associated with these attitudes. DESIGN, SETTING, AND PARTICIPANTS For this population-based survey study of US Medicare beneficiaries 65 years and older, data were obtained from the Medication Attitudes module fielded through in-person interviews in round 6 of the National Health and Aging Trends Study (weighted response rate of round 6 was 88.5%). The questions in this module were drawn from the Patients' Attitudes Towards Deprescribing questionnaire and its revised version. The Medication Attitudes module was fielded to a random one-third (n = 2124) of the National Health and Aging Trends Study participants (weighted response rate of this module was 94.8%). MAIN OUTCOMES AND MEASURES Responses to 2 statements ("If my doctor said it was possible, I would be willing to stop one or more of my regular medicines" and "I would like to reduce the number of medicines I am taking") were the main outcomes of interest. RESULTS Of the 1981 Medicare beneficiaries included in the study, 1149 (55.2%, weighted) were women, and the majority (n = 715 [54.6%, weighted]) were 65 to 74 years old. A total of 1752 (92.0%, weighted) older adults reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 1241 (66.6%, weighted) older adults wanted to reduce the number of medicines that they were taking. Older adults taking 6 or more medications had greater odds than those taking fewer than 6 medications of being willing to stop taking 1 or more of their medicines (adjusted odds ratio, 2.90; 95% CI, 1.74-4.82) and wanting to reduce the number of medicines that they were taking (adjusted odds ratio, 2.31; 95% CI, 1.71-3.13). CONCLUSIONS AND RELEVANCE Physicians considering deprescribing as part of comprehensive, patient-centered care should be reassured that a majority of older Americans are open to having 1 or more of their medicines deprescribed if their physician says it is possible, and more than two-thirds want to reduce the number of medicines that they are taking.

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People's Attitudes, Beliefs, and Experiences Regarding Polypharmacy and Willingness to Deprescribe

Cited by 185 publications

References 42 publications

Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

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