This study provides a novel typology to describe differences between older people who are happy to take multiple medicines, and those who are open to deprescribing. To enable shared decision-making, prescribers need to adapt their communication about polypharmacy based on their patients' attitudes to medicines and preferences for involvement in decisions.
Background Harmful and/or unnecessary medications use in older adults is common. This indicates deprescribing (supervised withdrawal of inappropriate medicines) is not happening as often as it should. This study aimed to synthesise the results of the Patients’ Attitudes Towards Deprescribing (PATD) questionnaire (and revised versions). Methods Databases were searched from January 2013 to March 2020. Google Scholar was used for citation searching of the development and validation manuscripts to identify original research using the validated PATD, revised PATD (older adult and caregiver versions) and the version for people with cognitive impairment (rPATDcog).Two authors extracted data independently. A meta-analysis of proportions (random-effects model) was conducted with sub-group meta-analyses for setting and population.The primary outcome was the question: “If my doctor said it was possible, I would be willing to stop one or more of my medicines”. Secondary outcomes were associations between participant characteristics and primary outcome and other (r)PATD results. Results We included 46 articles describing 40 studies (n = 10,816 participants). The meta-analysis found the proportion of participants who agreed or strongly agreed with this statement was 84% ((95% CI 81% - 88%) and 80% (95% CI 74% - 86%) in patients and caregivers respectively, with significant heterogeneity (I2 = 95% and 77%). Conclusion Consumers reported willingness to have a medication deprescribed although results should be interpreted with caution due to heterogeneity. The findings from this study moves towards understanding attitudes towards deprescribing, which could increase the discussion and uptake of deprescribing recommendations in clinical practice.
Digital health applications (apps) have the potential to improve health behaviors and outcomes. We aimed to examine the effectiveness of a consumer web-based app linked to primary care electronic health records (EHRs). CONNECT was a multicenter randomized controlled trial involving patients with or at risk of cardiovascular disease (CVD) recruited from primary care (Clinical Trial registration ACTRN12613000715774). Intervention participants received an interactive app which was pre-populated and refreshed with EHR risk factor data, diagnoses and, medications. Interactive risk calculators, motivational messages and lifestyle goal tracking were also included. Control group received usual health care. Primary outcome was adherence to guideline-recommended medications (≥80% of days covered for blood pressure (BP) and statin medications). Secondary outcomes included attainment of risk factor targets and eHealth literacy. In total, 934 patients were recruited; mean age 67.6 (±8.1) years. At 12 months, the proportion with >80% days covered with recommended medicines was low overall and there was no difference between the groups (32.8% vs. 29.9%; relative risk [RR] 1.07 [95% CI, 0.88–1.20] p = 0.49). There was borderline improvement in the proportion meeting BP and LDL targets in intervention vs. control (17.1% vs. 12.1% RR 1.40 [95% CI, 0.97–2.03] p = 0.07). The intervention was associated with increased attainment of physical activity targets (87.0% intervention vs. 79.7% control, p = 0.02) and e-health literacy scores (72.6% intervention vs. 64.0% control, p = 0.02). In conclusion, a consumer app integrated with primary health care EHRs was not effective in increasing medication adherence. Borderline improvements in risk factors and modest behavior changes were observed.
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