Jungo KT, Weir KR, Cateau D, Streit S. Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial. BMJ Open. 2024 Jan 10;14(1):e075325. doi: 10.1136/bmjopen-2023-075325. PMID: 38199626; PMCID: PMC10806786.
The study aimed to explore the link between older patients’ willingness to have medications deprescribed and the outcomes related to medication changes, medication appropriateness, and the adoption of prescribing recommendations from the electronic decision support system in the OPTICA trial. It was conducted as a longitudinal sub-study within the OPTICA trial across various Swiss primary care settings involving 43 general practitioner practices.
This post-hoc sub-study of the OPTICA trial recruited 323 patients aged 65 or older with multiple chronic conditions and polypharmacy. Participants were randomly assigned to either an intervention or control group, with the intervention group undergoing a structured medication review using an electronic clinical decision support system. The study assessed patients’ willingness to deprescribe at baseline using the rPATD questionnaire and evaluated medication-related outcomes over a 12-month period. Multilevel regression analyses examined associations between patients’ attitudes towards deprescribing and medication-related outcomes.
The study findings revealed that the median age of participants was 78 years, with 45% being women. The analysis encompassed 298 participants, the majority (75%) had equal- or higher-than-median willingness to deprescribe medications at baseline. While assessing patients’ attitudes towards deprescribing, the study identified a high agreement rate with hypothetical deprescribing across various measures. Over a 12-month follow-up period, the mean change in the number of medications was minimal (-0.2), with a significant association observed only between patients’ concerns about stopping medications and changes in medication count. However, there was no significant association between patients’ willingness to deprescribe and changes in medication appropriateness or the implementation of deprescribing recommendations. The study suggests that despite high agreement rates with deprescribing, such attitudes did not translate into tangible changes in medication management. The study’s strengths include its longitudinal design and comprehensive assessment of patients’ attitudes towards deprescribing, while limitations include potential participant selection bias, reliance on electronic health records for medication data, and potentially being underpowered to detect certain clinically meaningful effects.
“We found inconclusive evidence on the association between (hypothetical) patient attitudes towards deprescribing and actual medication changes over 1 year. Granted there are many different, actionable steps and potential barriers that lay between patients’ expressing their willingness to discontinue medications and actual changes to their medication. This shows that communication during healthcare encounters must not only elicit patient attitudes and preferences, but also address the multifaceted existing hurdles to successful medication discontinuation. We also need better measures to more accurately reflect patients’ deprescribing attitudes in real-life clinical situations.“
