Exploring Patients’ Attitudes Toward Deprescribing and Their Perception of Pharmacist Involvement in a European Country: A Cross-Sectional Study

Abstract

Purpose To explore how adult patients perceive deprescribing in a country with developing pharmaceutical care. Patients and Methods This was a multicenter cross-sectional study conducted in ten community pharmacies across Croatia. Community-dwelling adults 40 years and older, taking at least one prescription medication long term, were invited to participate. The revised and validated Patients’ Attitude Towards Deprescribing Questionnaire was used to investigate community-dwelling adults’ opinions on potential medication discontinuation. Questions regarding the patients’ perception of pharmacist competences and involvement as well as patients’ preferences in deprescribing were added. Collected data were analyzed using IBM SPSS Statistics using descriptive and inferential statistical analysis. Binary logistic regression was used to explore potential predictive factors of willingness to have medication deprescribed. All tests were performed as two-tailed and a p < 0.05 was considered statistically significant. Results A total of 315 adults aged 40 years and older completed the questionnaire. Majority of participants, 83.81% (95% CI, 79.72% to 87.90%) stated that they were satisfied with their medications, and 83.81% (95% CI, 79.72% to 87.90%) would be willing to deprescribe one or more medications. Participants expressed a positive attitude toward pharmacists’ competences (68.89%, 95% CI, 63.75% to 74.03%) and involvement in deprescribing (71.11%, 95% CI, 66.08% to 76.14%). Participants who stated specific medication as deprescribing preference were more likely show dissatisfaction with current medication and show greater willingness to have medication deprescribed. Three factors were found to be associated with a positive attitude towards deprescribing: low concerns about stopping factor score (aOR 0.54, 95% CU=0.35–0.84; p=0.006), low appropriateness factor score (aOR 0.62, 95% CI=0.39–0.98; p=0.039), and a positive opinion on pharmacist involvement (aOR 2.35, 95% CI=1.18–4.70; p= 0.016). Conclusion This study showed the patient’s willingness for deprescription as well as their positive attitude towards pharmacists being involved in the process. Results favour transition to a patient-centred care and shared-decision making model.

Attitudes and beliefs of older adults and caregivers towards deprescribing in French-speaking countries: a multicenter cross-sectional study

“…In our study, the willingness to have a medication deprescribed was signi cantly associated with two factors: a higher value for the involvement factor for both older adults and caregivers, as well as a low value for the concern about stopping factor, only for older adults. These results were also found in a cross-sectional study conducted in Croatia [27]. Indeed, participants who want to be involved in discussions regarding medication management and who have fewer concerns about drug discontinuation, are probably more likely to be open to deprescribing.…”

“…The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed by Reeve et al [22] to capture attitudes and beliefs towards deprescribing among older adults and caregivers. This original English questionnaire was used internationally in different countries and settings, and was translated if needed in different languages [23][24][25][26][27][28]. Previous international studies have reported older adults' and caregivers' openness to deprescribing, but few have concurrently assessed older adults' and caregivers' attitudes.…”

Attitude towards deprescribing and its association with frailty and complexity of medication regimen: A survey of older inpatients in a district health board in New Zealand

“…There is conflicting evidence regarding the association of the number of medications with willingness to deprescribe. Some studies reported a significant association [ 33 , 34 ] similar to our findings whilst others have shown no significant association [ 30 , 31 , 35 , 36 ]. This difference might be due to differences in the population characteristics.…”

“…Consistent with previous community based studies, participants in our study reported a greater desire to be involved in decision-making [ 30 ]. This contrasts a study conducted in inpatient setting in the UK, where participants had a lower desire to be involved in decision-making [ 32 ].…”

A pharmacist-led medication review service with a deprescribing focus guided by implementation science

“…A recent systematic review showed high patient satisfaction toward pharmacist-led medication review interventions ( Bou Malham et al, 2021 ). In addition, patients showed a positive attitude toward pharmacists’ competencies and involvement in deprescribing, especially the elderly ( Bužančić et al, 2021 ). Further, a study reported that patient satisfaction could be enhanced by deprescribing as patients felt uncomfortable with the use of multiple medications ( Reeve et al, 2014 ).…”