Deprescribing practices, habits and attitudes of geriatricians and geriatricians-in-training across Europe: a large web-based survey

Abstract

Purpose To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. Methods An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing approaches and practices, deprescribing education and knowledge, and facilitators/barriers of deprescribing. Responses to the survey questions and participant characteristics were quantified and differences evaluated between geriatricians and geriatricians-in-training and between European regions. Results The 964 respondents (median age 42 years old; 64% female; 21% geriatricians-in-training) were generally willing to deprescribe (98%) and felt confident about deprescribing (85%). Despite differences across European regions, the most commonly reported reasons for deprescribing were functional impairment and occurrence of adverse drug reactions. The most important barriers for deprescribing were patients’ unwillingness, fear of negative consequences, lack of time, and poor communication between multiple prescribers. Perceived risk of adverse drug reactions was highest for psychotropic drugs, nonsteroidal anti-inflammatory drugs, cardiovascular drugs, and opioid analgesics. Only one in four respondents (23% of geriatricians and 37% of geriatricians-in-training) think education in medical school had sufficiently prepared them for deprescribing in clinical practice. They reported that their future deprescribing activities would probably increase with improved information sharing between various prescribers, deprescribing recommendations in guidelines, and increased education and training. Approximately 90% think that a paradigm shift is required for prescribers and patients, increasing focus on the possible benefits of deprescribing (potentially) inappropriate medications. Conclusions Based on the outcomes of this survey, we recommend investing in improved inter-professional communication, better education and evidence-based recommendations to improve future patient-centered deprescribing practices.

What is the association of polypharmacy with frailty in heart failure? A systematic review and meta-analysis

“…In fact, Essa et al recently demonstrated that a multispecialty multidisciplinary intervention reduced hospitalizations due to adverse drug reactions by significantly reducing the anticholinergic burden in patients with HF[ 41 ]. In particular, a multidisciplinary team could be crucial for the following actions: optimize HF therapy by prescribing appropriate HF-related drugs in line with guideline recommendations, such as ARNI, BB, SGLT2i, and MRA (“good” polypharmacy); deprescribing or reconsidering the dose of HF-related drugs that may increase the risk of negative effects such as orthostatic hypotension and fall in older adults with frailty, assuming administration of diuretics and/or SGLT2i; deprescription of HF-unrelated drugs such as benzodiazepines, antihistamines, anticholinergics and antipsychotics that may increase risk of falls, cognitive dysfunction, and functional decline[ 42 ].…”

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“…Several factors contribute to prescribing inertia in primary care in Greece and other European countries: lack of time, lack of information sharing among primary care practitioners and specialists, lack of structured special geriatric education [ 28 , 29 ], inadequate numbers of health workforce and inadequate financial motivation [ 30 ]. It should also be noted that part of our data was based on self-report of the participants, so it is possible that patients may have failed to mention certain medical conditions, leading to a false identification of STOPP PIMs.…”

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“…According to a recent European survey among geriatricians and geriatricians-in-training, the most important barriers for deprescribing were patients’ unwillingness, fear of negative consequences, lack of time, and poor communication between multiple prescribers [ 57 ]. The respondents stated that their future deprescribing activities would probably increase with improved information sharing between various prescribers, deprescribing recommendations in guidelines, and increased education and training [ 57 ].…”