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Background Knowledge of decision-making preference of patients and caregivers is needed to facilitate deprescribing. This study aimed to assess the perspectives of caregivers and older adults towards deprescribing in an Asian population. Secondary objectives were to identify and compare characteristics associated with these attitudes and beliefs. Method A cross-sectional survey of two groups of participants was conducted using the Revised Patients’ Attitudes Towards Deprescribing questionnaire. Descriptive results were reported for participants’ characteristics and questionnaire responses from four factors (belief in medication inappropriateness, medication burden, concerns about stopping, and involvement) and two global questions. Correlation between participant characteristics and their responses was analyzed. Results A total of 1,057 (615 older adults; 442 caregivers) participants were recruited from 10 institutions in Singapore. In which 511 (83.0%) older adults and 385 (87.1%) caregivers reported that they would be willing to stop one or more of their medications if their doctor said it was possible, especially among older adults recruited from acute-care hospitals (85.3%) compared with older adults in community pharmacies (73.6%). Individuals who take more than five medications and those with higher education were correlated with greater agreement in inappropriateness and involvement, respectively. Conclusions Clinicians should consider discussing deprescribing with older adults and caregivers in their regular clinical practice, especially when polypharmacy is present. Further research is needed into how to engage older adults and caregivers in shared decision making based on their attitudes toward deprescribing.

Background: The effects of polypharmacy and its related adverse outcomes are well documented among elderly patients. Deprescribing is now recognised as an important part of medication review in addressing polypharmacy. However, little is currently known about local practices in discontinuing medications as a means to improve quality of life. There are two aims in this study: first, to explore the attitudes and beliefs of deprescribing medications among doctors in the Department of Internal Medicine (DIM) in Singapore General Hospital (SGH), and second, to see if differences exist among junior and senior doctors in their attitudes towards deprescribing. Methods: A descriptive survey was designed to look at the attitudes and beliefs of doctors towards deprescribing. All doctors in the department were invited to complete the survey. Results: The majority of doctors (66%) believed that deprescribing is beneficial for patients. Commonly cited barriers towards deprescribing were unwillingness to stop medications prescribed by another doctor, lack of time and insufficient knowledge. Lack of a specific approach to deprescribing was noted among 73% of the participants. A third of the juniors (32%) stated that they were reluctant to deprescribe medications, which was in contrast to the responses by the seniors, most of whom (94%) indicated no reluctance in deprescribing medications. Conclusion: Most doctors believe that deprescribing is beneficial to patients. Specific measures to target the barriers faced by doctors in deprescribing medications are necessary to improve deprescribing rates and minimising polypharmacy.

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Background Vancomycin therapeutic drug monitoring (TDM) is commonly performed to ensure safe and effective use of the antibiotic. Aim of Study To evaluate appropriateness of vancomycin TDM and its outcomes in Singapore General Hospital. Method A retrospective, cross-sectional study was conducted between 1 January 2014 and 28 February 2014 involving patients who received ≥ 1 dose of intravenous vancomycin with TDM. Patient demographics and relevant vancomycin TDM data were collected from medical records. Results Of 746 vancomycin troughs measured among 234 patients, 459 troughs (61.5%) were taken inappropriately, with a median time of 2.6 h (interquartile range 1.1-4.3) before the next scheduled dose. Inappropriate interpretation of vancomycin troughs resulted in 41 unnecessary dose suspensions, 24 dose changes, and 102 unchanged vancomycin doses. The cost incurred due to inappropriate interpretation and measurement after discontinuation of treatment was US$7286. No differences in rates of vancomycin related nephrotoxicity, ototoxicity, recurrent infection, development of infection secondary to vancomycin resistant microorganism and mortality were observed (p > 0.05). Conclusion This study highlighted a high incidence of inappropriate vancomycin TDM which has led to increased healthcare cost.