Baseline characteristics and comparability of older multimorbid patients with polypharmacy and general practitioners participating in a randomized controlled primary care trial

Abstract

Objectives Recruiting general practitioners (GPs) and their multimorbid older patients for trials is challenging for multiple reasons (e.g., high workload, limited mobility). The comparability of study participants is important for interpreting study findings. This manuscript describes the baseline characteristics of GPs and patients participating in the ‘Optimizing PharmacoTherapy in older multimorbid adults In primary CAre’ (OPTICA) trial, a study of optimization of pharmacotherapy for multimorbid older adults. The overall aim of this study was to determine if the GPs and patients participating in the OPTICA trial are comparable to the real-world population in Swiss primary care. Design Analysis of baseline data from GPs and patients in the OPTICA trial and a reference cohort from the FIRE (‘Family medicine ICPC Research using Electronic medical records’) project. Setting Primary care, Switzerland. Participants Three hundred twenty-three multimorbid (≥ 3 chronic conditions) patients with polypharmacy (≥ 5 regular medications) aged ≥ 65 years and 43 GPs recruited for the OPTICA trial were compared to 22,907 older multimorbid patients with polypharmacy and 227 GPs from the FIRE database. Methods We compared the characteristics of GPs and patients participating in the OPTICA trial with other GPs and other older multimorbid adults with polypharmacy in the FIRE database. We described the baseline willingness to have medications deprescribed of the patients participating in the OPTICA trial using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Results The GPs in the FIRE project and OPTICA were similar in terms of sociodemographic characteristics and their work as a GP (e.g. aged in their fifties, ≥ 10 years of experience, ≥ 60% are self-employed, ≥ 80% work in a group practice). The median age of patients in the OPTICA trial was 77 years and 45% of trial participants were women. Patients participating in the OPTICA trial and patients in the FIRE database were comparable in terms of age, certain clinical characteristics (e.g. systolic blood pressure, body mass index) and health services use (e.g. selected lab and vital data measurements). More than 80% of older multimorbid patients reported to be willing to stop ≥ 1 of their medications if their doctor said that this would be possible. Conclusion The characteristics of patients and GPs recruited into the OPTICA trial are relatively comparable to characteristics of a real-world Swiss population, which indicates that recruiting a generalizable patient sample is possible in the primary care setting. Multimorbid patients in the OPTICA trial reported a high willingness to have medications deprescribed. Trial registration Clinicaltrials.gov (NCT03724539), KOFAM (Swiss national portal) (SNCTP000003060), Universal Trial Number (U1111-1226-8013)

The impact of the COVID-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings: A mixed-methods study

“…The FIRE project is mostly limited to the Swiss German speaking part of Switzerland, and it is not a random sample, as GPs self-select into the project by voluntary participation. However, a recent study showed that the GPs participating in the FIRE project are comparable to the entire GP workforce in Switzerland in terms of age, work experience, sex, and work percentage ( Jungo et al, 2021 ). Despite this, since GPs self-select to join the FIRE project, we would like to highlight that there may be several unmeasured differences between the GPs who participate in the FIRE database and those who do not.…”

Differences in Older Patients' Attitudes Toward Deprescribing at Contextual and Individual Level

“…In other studies, these percentages of being unsure were <10% (10, 14-18). A higher willingness was observed in high-income countries as compared to low-middle-income countries (n = 12, ANOVA, F 15.426, p-value 0.002), with highest percentages in the USA (average 91%) (16,19), followed by Australia (88%) (18), and European countries (average 87%) (8,10,14,15,17,20,21). Intermediate precentages were seen in Singapore (83%) and Ethiopia (82%) (11,22), whereas the lowest percentages were observed in Nepal and Malaysia (57%, 68%) (6,13).…”

Swiss GPs’ preferences for antidepressant treatment in mild depression: vignette-based quantitative analysis

“…The response rate was approximately 20%, so the external validity of the study findings may be limited if survey respondents were not representative of the German-speaking Swiss GP population. While GP mean age, work location and setting closely matched the characteristics of the GPs included in the FIRE database and the Swiss GP population, with 44% female GPs were overrepresented in this study (women account for only 35% of the FIRE database and 36% of the Swiss GP workforce) [ 45 ]. Finally, it is also possible that the questionnaire was mostly completed by GPs with a special interest in depression, which may introduce bias.…”