Patients’ attitudes toward deprescribing and their experiences communicating with clinicians and pharmacists

Abstract

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18 years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and pharmacists, and the revised Patients’ Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants ( n = 65 identified as female and n = 74 as White/Caucasian) with a mean age of 50.4 years [standard deviation (SD) = 15.5]. Participants reported taking an average of 8.4 daily medications (SD = 6.1). Most participants reported effective communication with clinicians and pharmacists (66.9%) and expressed willingness to stop one of their medications if their clinician said it was possible (83.5%). Predictors of willingness to accept deprescribing were older age [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.45–6.2], college/graduate degree (OR = 55.25, 95% CI = 5.74–531.4), perceiving medications as less appropriate (OR = 8.99, 95% CI = 1.1–73.62), and perceived effectiveness of communication with the clinician or pharmacist (OR = 4.56, 95% CI = 0.85–24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept deprescribing of medications when their doctor said it was possible. Targeted strategies to facilitate communication within the patient–primary care clinician–pharmacist triad that consider patient characteristics such as age and education level may be necessary ingredients for developing successful deprescribing interventions. Plain Language Summary Are patients willing to accept stopping medications? Sometimes, medicines that a patient takes regularly become inappropriate. In other words, the risks of adverse effects might be greater than a medicine’s potential benefits. The decision to stop such medicines should involve the patient and consider their preferences. We surveyed a group of patients taking multiple medicines to see how they felt about having those medicines stopped. We also asked patients whether and how much they talk to their primary care clinician and pharmacists about their medicines. To qualify for this study, patients had to be at least 18 years old and to take three or more medicines daily; they also needed to speak English. Participants provided demographic information and answered questions about their medicines, their communication with primary care clinicians and pharmacists, and their feelings about having one or more of their medicines stopped. We recruited 107 people and were able to use responses from 103 of them. Their average age was 50 years; 65 of them identified as female, and 75 identified as White/Caucasian. Most of our participants mentioned having conversations with primary care clinicians and pharmacists and said they would be willing to stop a medication if their clinician said it was possible. Older participants, those with more years of education, those who thought their medications might lead to side effects, and those who communicated with their clinician or pharmacists were more willing to have one of their medicines stopped. Our results indicate that patient characteristics and communication with clinicians and pharmacists are factors to consider when designing interventions to reduce the use of inappropriate medicines.

Predictors of older patients' willingness to have medications deprescribed: A cross‐sectional study

“…To the best of our knowledge, this is the first time that sex has been reported as a predictor of the willingness to have medications deprescribed. Previous studies found that the association between participants' sex and the willingness to have medications deprescribed was not significant 20–23,26,27,30,33,35,37–39,44 . Our result may be partly explained by the noteworthy differences between women and men in their medication adherence, with women being less likely to follow preventive guidance and less adherent to medicines 60,61 .…”

“…For example, age and willingness to have medications deprescribed were found to be positively associated in four studies, 20,21,29,30 negatively associated in another four studies, 18,19,22,31 and non‐significant in 15 other studies 23–27,32–41 . Among the 21 studies that examined the association between patient willingness to have a medication deprescribed and the number of medications, three found a positive association, 20,22,23 one a negative association, 34 and 17 found no significant association 21,24–27,29,30,32,33,36,37,39,40,42–45 . These unclear findings support the need for more research on what factors are associated with the patients' willingness to have their medications deprescribed.…”

“…In studies using the PATD or rPATD questionnaires, there is mixed evidence on the associations between certain patients' characteristics and their willingness to have their medications deprescribed. For example, age and willingness to have medications deprescribed were found to be positively associated in four studies, 20,21,29,30 negatively associated in another four studies, 18,19,22,31 and non‐significant in 15 other studies 23–27,32–41 . Among the 21 studies that examined the association between patient willingness to have a medication deprescribed and the number of medications, three found a positive association, 20,22,23 one a negative association, 34 and 17 found no significant association 21,24–27,29,30,32,33,36,37,39,40,42–45 .…”

Attitudes towards deprescribing and patient-related factors associated with willingness to stop medication among older patients with type 2 diabetes (T2D) in Indonesia: a cross-sectional survey study

“…This may lead to not preferring any other pharmacist services than the short face-to-face consultation when collecting the medication [ 25 ]. In a study conducted in the USA, one in five patients indicated never communicating with the pharmacist, but when such communication was perceived effective it was associated with a higher willingness to accept deprescribing [ 14 ]. A study in Singapore found that only half of the patients felt comfortable with pharmacists being involved in the deprescribing process in primary care [ 26 ], while more than 70% of patients in Croatia had a positive opinion on pharmacists’ involvement in deprescribing [ 12 ]..…”

“…One study in Croatia found that patients were comfortable with pharmacists’ involvement in deprescribing process, and that they had a positive opinion on their pharmacists’ competencies regarding deprescribing [ 12 ]. In addition, patients who perceived more effective communication with their general practitioner or pharmacist were more willing to accept deprescribing [ 14 ]. At country level, it was found that patients in low-middle-income countries (LMIC) may be less willing to stop medication compared to high-income countries [ 9 ].…”