Patients’ and Caregivers’ Attitudes Toward Deprescribing in Singapore

Kua, Chong Han; Reeve, Emily; Tan, Doreen Su‐Yin; Koh, Tsingyi; Soong, Jie Lin; Sim, Marvin J.L.; Zhang, Tracy Y.; Chen, Yi Rong; Ratnasingam, Vanassa; Mak, Vivienne; Lee, Shaun Wen Huey

doi:10.1093/gerona/glaa018

Cited by 20 publications

(39 citation statements)

References 37 publications

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“…Our finding that most participants (89%) would be willing to stop one of their regular medications on their physician's advice is in accordance with previous literature 8‐12,21‐23 . Interestingly, only one third reported an intrinsic desire to try stopping one of their medications.…”

Section: Discussionsupporting

confidence: 91%

“…Successful deprescribing requires exploring patients' feelings about taking medication, discussing goals and treatment preferences, and addressing questions and concerns 6 . One way to explore patients' feelings about medication use is by use of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire, 7 which has been widely used to explore attitudes across patient populations 8‐11 . However, while the majority of previous studies concern older people in general, only few studies assess the attitudes of older people with frailty and/or limited life expectancy 12 for whom deprescribing is particularly relevant.…”

Section: Introductionmentioning

confidence: 99%

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Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Lundby

Glans

Simonsen

et al. 2021

J American Geriatrics Society

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Background/Objectives Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents. Design Interview‐based questionnaire study. Setting Denmark. Participants Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation‐Memory‐Concentration score of ≥8. Measurements Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics. Results Participants had a median age of 82 years (interquartile range [IQR] 76–89) and used a median of 8 medications (IQR 5–10). Thirty‐three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden” score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median “involvement” score 80 vs 75, p < 0.05) and geriatric inpatients (median “involvement” score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased “burden” score (ptrend = 0.001): Those using 1–4 medications daily had a median score of 25 (IQR 17–33) compared to 58 (IQR 42–75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping” score (ptrend = 0.001) and a lower "appropriateness” score (ptrend < 0.001), respectively. Conclusion Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Lundby

Glans

Simonsen

et al. 2021

J American Geriatrics Society

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“…These findings are in line with previous research. Another study conducted in Switzerland found that 77% of older adults would be willing to stop one or more of their medications [39] and similar proportions were found in studies in other countries (88% in Australia [47], 92% in the United States [50], 83% in Singapore [51]). While these numbers have to be interpreted with caution (e.g.…”

Section: Characteristicssupporting

confidence: 65%

Baseline characteristics and comparability of older multimorbid patients with polypharmacy and general practitioners participating in a randomized controlled primary care trial

et al. 2021

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Objectives Recruiting general practitioners (GPs) and their multimorbid older patients for trials is challenging for multiple reasons (e.g., high workload, limited mobility). The comparability of study participants is important for interpreting study findings. This manuscript describes the baseline characteristics of GPs and patients participating in the ‘Optimizing PharmacoTherapy in older multimorbid adults In primary CAre’ (OPTICA) trial, a study of optimization of pharmacotherapy for multimorbid older adults. The overall aim of this study was to determine if the GPs and patients participating in the OPTICA trial are comparable to the real-world population in Swiss primary care. Design Analysis of baseline data from GPs and patients in the OPTICA trial and a reference cohort from the FIRE (‘Family medicine ICPC Research using Electronic medical records’) project. Setting Primary care, Switzerland. Participants Three hundred twenty-three multimorbid (≥ 3 chronic conditions) patients with polypharmacy (≥ 5 regular medications) aged ≥ 65 years and 43 GPs recruited for the OPTICA trial were compared to 22,907 older multimorbid patients with polypharmacy and 227 GPs from the FIRE database. Methods We compared the characteristics of GPs and patients participating in the OPTICA trial with other GPs and other older multimorbid adults with polypharmacy in the FIRE database. We described the baseline willingness to have medications deprescribed of the patients participating in the OPTICA trial using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Results The GPs in the FIRE project and OPTICA were similar in terms of sociodemographic characteristics and their work as a GP (e.g. aged in their fifties, ≥ 10 years of experience, ≥ 60% are self-employed, ≥ 80% work in a group practice). The median age of patients in the OPTICA trial was 77 years and 45% of trial participants were women. Patients participating in the OPTICA trial and patients in the FIRE database were comparable in terms of age, certain clinical characteristics (e.g. systolic blood pressure, body mass index) and health services use (e.g. selected lab and vital data measurements). More than 80% of older multimorbid patients reported to be willing to stop ≥ 1 of their medications if their doctor said that this would be possible. Conclusion The characteristics of patients and GPs recruited into the OPTICA trial are relatively comparable to characteristics of a real-world Swiss population, which indicates that recruiting a generalizable patient sample is possible in the primary care setting. Multimorbid patients in the OPTICA trial reported a high willingness to have medications deprescribed. Trial registration Clinicaltrials.gov (NCT03724539), KOFAM (Swiss national portal) (SNCTP000003060), Universal Trial Number (U1111-1226-8013)

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“…One study presented factor scores on a scale up to 100 (10), which we divided by 20 to represent the original scale up to 5. For one study that presented "inappropriateness" without carrying out the inverse scoring (11), we reversed the scores and reported associations. We tested for differences at study level in (a) willingness to stop medication, (b) satisfaction with medication, and (c) the four rPATD factors using ANOVA, comparing global regions (USA, Europe, Australia, Asia, Africa), high-income versus lowmiddle-income countries (OECD classification), and healthcare settings (primary care, outpatient, inpatient, nursing home).…”

Section: Methodsmentioning

confidence: 99%

Differences in Older Patients' Attitudes Toward Deprescribing at Contextual and Individual Level

Oktora

Edwina

Denig

2022

Front. Public Health

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BackgroundDeprescribing requires patients' involvement and taking patients' attitudes toward deprescribing into account. To understand the observed variation in these attitudes, the influence of contextual-level factors, such as country or healthcare setting, should be taken into account.MethodsWe conducted a systematic review of studies using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire among older adults. We searched articles in Medline and Embase up to 30 June 2021. PRISMA guideline was used for the search process and reporting. We summarized the outcomes from the rPATD and compared attitudes at study population level between high or low-middle-income countries, global regions, and healthcare settings using ANOVA testing. Correlations of the rPATD outcomes with the mean age of the study populations were tested. Associations with the rPATD outcomes at individual patient level extracted from the included studies were summarized.ResultsSixteen articles were included. Percentages of patients willing to stop medication were significantly lower in low-middle-income countries (<70% in Nepal and Malaysia) compared to high-income countries (>85% in USA, Australia, European countries). No significant differences were observed when results were compared by global region or by healthcare setting but a high willingness (>95%) was seen in the two studies conducted in an inpatient population. A higher mean age at study level was associated with a higher willingness to stop medication. At individual level, associations between patient characteristics, including demographics and education, and attitudes toward deprescribing showed inconsistent results.ConclusionFindings about attitudes toward deprescribing are influenced by contextual factors. Future research should pay more attention to the influence of the healthcare system and setting as well as the culture on patients' attitudes.

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Patients’ and Caregivers’ Attitudes Toward Deprescribing in Singapore

Cited by 20 publications

References 37 publications

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Baseline characteristics and comparability of older multimorbid patients with polypharmacy and general practitioners participating in a randomized controlled primary care trial

Differences in Older Patients' Attitudes Toward Deprescribing at Contextual and Individual Level

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