Understanding older patients’ willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries

Abstract

Introduction To reduce inappropriate polypharmacy, deprescribing should be part of patients’ regular care. Yet deprescribing is difficult to implement, as shown in several studies. Understanding patients’ attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults’ perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients’ willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions. Methods and analysis This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (n = 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients’ medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements. Discussion The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients’ preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs’ and patients’ views and preferences on stopping or reducing specific medications. Our findings will help to understand patients’ attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients’ preferences.

Deprescribing in a multimorbid older adult: A case vignette study among community pharmacists and primary care physicians

“…Physicians should routinely ask patients on usage, and pharmacists should attentively counsel patients when recommending any over‐the‐counter medication, herbal or dietary supplements. Efforts have been made to explore physicians and patients' willingness to deprescribe dietary and herbal supplements 37 …”

“…Efforts have been made to explore physicians and patients' willingness to deprescribe dietary and herbal supplements. 37 Overall physicians were more likely to accept deprescribing rationales than pharmacists were to give them, what applied to all medications from the patient vignette. Reasons could include, for instance, age and experience or confidence in therapy decisions.…”

“…No indication/lack of prescribing justification 254 (20%) ASA (74), furosemide (60), opioid (41), NSAID (37), PPI (15), lactulose (6), zolpidem (6), bisoprolol (5), multivitamin (4), alprazolam (3), moxonidine (2), solifenacin (1) Reduce dose/dosing 215 (17%) PPI (38), allopurinol (30), amlodipine/valsartan (29), furosemide (22), NSAID (17), alprazolam (16), moxonidine (16), bisoprolol (12), opioid (10), zolpidem (9), solifenacin (7), ASA (4), lactulose (3), escitalopram…”

The Patient Typology about deprescribing and medication‐related decisions: A quantitative exploration

“…19 It is gaining interest in the deprescribing field and has been used in interventional studies, 20,21 a qualitative study 15 and survey study. 22 This indicates that it is applicable in a variety of deprescribing studies. However, qualitative methods can be time consuming.…”

“…Our Patient Typology (Figure 1) has been rigorously developed using qualitative methods and informed by a theoretical shared decision‐making framework 19 . It is gaining interest in the deprescribing field and has been used in interventional studies, 20,21 a qualitative study 15 and survey study 22 . This indicates that it is applicable in a variety of deprescribing studies.…”