General practitioners’ views on (long-term) prescription and use of problematic and potentially inappropriate medication for oldest-old patients—A qualitative interview study with GPs (CIM-TRIAD study)

Pohontsch, Nadine Janis; Heser, Kathrin; Löffler, Antje; Haenisch, Britta; Parker, Debora; Luck, Tobias; Riedel‐Heller, Steffi G.; Maier, Wolfgang; Jessen, Frank; Scherer, Martin

doi:10.1186/s12875-017-0595-3

Cited by 28 publications

(35 citation statements)

References 46 publications

(92 reference statements)

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“…Tools to reduce PIMs, such as the PRISCUS list [26], Beers criteria [6], the Screening Tool of Older People's Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria [7], exist, but studies have shown that family physicians do not necessarily use them because of negative views [27]. Although physicians are aware of PIM and polypharmacy [27], medication they consider as potentially inappropriate does not necessarily match established criteria such as the PRISCUS list. Interestingly, only a limited number of medication classes were involved in most PIMs.…”

Section: Discussionmentioning

confidence: 99%

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Schnegg

Senn

Bugnon

et al. 2019

Drugs - Real World Outcomes

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Background We sought to estimate the prevalence of polypharmacy, the most prevalent drug classes involved, and the prevalence and type of potentially inappropriate prescribing among older male and female patients in family medicine. Methods We conducted a secondary analysis of baseline data from a pragmatic cluster-randomised trial on the efficacy of a screening and management tool for geriatric syndromes among older community-dwelling patients (aged ≥ 75 years) included by 42 family physicians. Information on drug prescription and clinical diagnoses (International Classification of Primary Care-2nd Edition [ICPC-2] coded) were extracted manually from medical records. The prevalence of polypharmacy, defined as the use of at least five permanent oral or parenteral drugs, and of potentially inappropriate medications (PIMs), identified according to 2015 updated Beers criteria, were compared between men and women. Results We included 429 patients (269 women and 160 men; mean age 82.9 and 81.8 years, respectively). Polypharmacy was found in 59.9% of them. Analgesics, antithrombotic agents and agents acting on the renin-angiotensin system were the most frequently prescribed drug categories. Three-quarters of patients (76.7%) were prescribed at least one PIM according to Beers criteria, without difference by sex/gender (p = 0.760). The most frequent PIMs were proton-pump inhibitors used for > 8 weeks, diuretics, benzodiazepines, aspirin for primary prevention, and chronic use of non-steroidal anti-inflammatory drugs. Prescription patterns markedly differed by sex/gender, but the number and patterns of inappropriate prescriptions were comparable overall. Interpretation Both polypharmacy and PIMs were very common in older patients followed regularly in family medicine in Switzerland. Interestingly, most PIMs involved only a limited number of medication classes. Trial registration Clinicaltrials.gov NCT 02618291.

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Section: Discussionmentioning

confidence: 99%

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Schnegg

Senn

Bugnon

et al. 2019

Drugs - Real World Outcomes

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“…We aimed to conduct interviews of full triads containing all three perspectives. We obtained 52 patient interviews (PIM: n = 27, non-PIM: n = 25), 52 GP interviews (PIM: n = 25, non-PIM: n = 22, others: 5; for results see [ 15 ]), and 48 interviews of significant others of the patients (PIM: n = 24, non-PIM: n = 24). Interviews of the triad were usually conducted separately.…”

Section: Methodsmentioning

confidence: 99%

Perspective of elderly patients on chronic use of potentially inappropriate medication – Results of the qualitative CIM-TRIAD study

et al. 2018

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Although potentially inappropriate medication (PIM) is associated with risk of harm due to adverse effects, it is frequently prescribed for elderly patients. The aim of this qualitative multi-center study was to gain insight into contextual factors that might lead to chronic PIM use. We conducted semi-structured interviews with elderly patients with or without chronic PIM use (patient interviews: n = 52). Patients were between 86 and 96 years old. The participants were recruited from the AgeCoDe study. Interviews were audiotaped and transcribed verbatim. The transcripts of the interviews were analysed using qualitative content analysis. Deductive and inductive categories were determined. We found contextual factors related to the patient and related to patient-general practitioner (GP) communication that might lead to chronic PIM use (i.e., positive features of PIM, maintaining characteristics of medication intake, barriers to deprescribe PIM, external actors supporting PIM intake, system-related factors). Besides certain health-related behaviours (e.g., own obligation to report to GP) and medication-related attitudes and knowledge (e.g., awareness of side effects and interaction of medicines), patient-GP-interactions that were characterised by mutual agreements on drugs (e.g., concerning dosage or discontinuation of a drug) might be advantageous to reduce the probability of chronic PIM use. The results might assist in the development of guidelines and educational programs aiming to reduce PIM use in the elderly.

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“…On the other hand, family physicians might feel compelled to keep the treatment initiated by other specialists, feel they do not have all the information needed to recommend a different treatment or patients might be resistant to change. 28…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network

Pinto

Rodrigues²,

Nunes³

2019

Acta Med Port

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Introduction: Type 2 diabetes is a major driver of pharmaceutical spending. We aimed to determine the proportion of new patients who begin treatment with each antidiabetic medicine class, if therapy was initiated by their family physician, if family physicians alter prescriptions initiated by other physicians, and to compare prescribing patterns of family physicians and other specialists.Material and Methods: Cohort-nested cross-sectional study within the Portuguese Sentinel Practice Network. Between 2014 and 2015, incident cases of type 2 diabetes were notified, thus reporting treatment, who made the initial prescription and if treatments initiated by other physicians were changed.Results: A total of 415 incident cases were notified. The initial prescription was made by Sentinel Practice Network physicians in 89.4% of cases (95% CI 86.0% - 92.0%). Metformin was most often chosen as the first treatment, prescribed to 85.5% of patients (95% CI 81.8% – 88.6%). Family physicians used less dipeptidyl peptidase-4 inhibitors (4.2% vs 30.3%, p < 0.001) and insulin (0.3% vs 12.1%, p < 0.001) compared to other specialists. Prescriptions initiated by others were changed in 4.5% of cases (95% CI 0.4% - 16.0%).Discussion: Prospective data collection is a major study strength, but few cases of treatment initiated by non-family physicians were notified. Data for disease severity was unavailable and could partly explain differences between family physicians and other specialists.Conclusion: Metformin was most often chosen as initial therapy, in line with Portuguese guideline recommendations. Sentinel Practice Network physicians diagnosed most cases, seldom changed prescriptions initiated by others, and had a different pattern of antidiabetic medicines use compared to other specialists.

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General practitioners’ views on (long-term) prescription and use of problematic and potentially inappropriate medication for oldest-old patients—A qualitative interview study with GPs (CIM-TRIAD study)

Cited by 28 publications

References 46 publications

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Perspective of elderly patients on chronic use of potentially inappropriate medication – Results of the qualitative CIM-TRIAD study

Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network

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