Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries

Streit, Sven; Verschoor, Marjolein; Rodondi, Nicolas; Bonfim, Daiana; Burman, Robert Anders; Collins, Claire; Biljana, Gerasimovska Kitanovska; Gintere, Sandra; Bravo, Raquel; Hoffmann, Kathryn; Iftode, Claudia; Johansen, Kasper L.; Kerse, Ngaire; Koskela, Tuomas; Peštić, Sanda Kreitmayer; Kurpas, Donata; Mallen, Christian; Maisoneuve, Hubert; Merlo, Christoph; Müeller, Yolanda; Muth, Christiane; Šter, Marija Petek; Petrazzuoli, Ferdinando; Rosemann, Thomas; Sattler, Martin; Švadlenková, Zuzana; Tatsioni, Athina; Thulesius, Hans; Ткаченко, В. І.; Torzsa, Péter; Tsopra, Rosy; Tuz, Canan; Viegas, Rita P. A.; Vinker, Shlomo; Waal, Margot W. M. de; Zeller, Andreas; Gussekloo, Jacobijn; Poortvliet, Rosalinde K. E.

doi:10.1186/s12877-017-0486-4

Cited by 29 publications

(43 citation statements)

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“…Considering the poor financial situation for many inhabitants of Western Balkan countries ( 29 ), using such medication could greatly burden a patient’s household or reduce compliance as Selmanovic et al found in their study ( 30 ). It would be interesting to explore in what way does a physician make a decision in favor of one brand when there are no restrictions placed by funds ( 31 , 32 ). All restrictions regarding medication prescribing competency of family physicians involving certain ARB antagonists, diuretics, or beta blockers should be reexamined and adjusted to best evidence-based recommendations ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries

Pekez-Pavliško¹,

Račić

Kusmuk

2017

Front. Public Health

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BackgroundDuring the transition processes, the Western Balkan countries were affected by conflicts and transition-related changes. Life expectancy in these countries is lower, while the mortality from non-communicable diseases (NCDs) is higher in comparison with western and northern parts of Europe. The primary aim of this study was to analyze the treatment possibilities for the most common NCDs in the Western Balkan countries. The secondary aim was to understand and compare the policies regarding prescribing-related competencies of family physicians.MethodsIn June and July 2017, a document analysis was performed of national positive medicines lists, strategic documents, and clinical guidelines for the treatment of the most frequent NCDs; arterial hypertension, diabetes, hyperlipidemia, asthma, and chronic obstructive pulmonary disease (COPD). All text phrases that referred to medicines prescribing were extracted and sorted into following domains: medicine availability, prescribing policy, and medication prescribing-related competencies.ResultsPossibilities for treatment of arterial hypertension, diabetes, hyperlipidemia, asthma, and COPD vary across the Western Balkan countries. This variance is reflected in the number of registered medicines, number of parallels, and number of different combinations, as well as restrictions placed on family physicians in prescribing insulin, inhaled corticosteroids, statins and angiotensin II receptor blockers (ARBs), without consultant’s recommendation.ConclusionWestern Balkan countries are capable of providing essential medicines for the treatment of NCDs, with full or partial reimbursement. There are some exceptions, related to statins, newer generation of oral antidiabetic agents and some of the antihypertensive combinations. Prescribing-related competences of family physicians are limited. However, this practice is not compliant to the practices of family medicine, its principles and primary care structures, and may potentially result in increased health-care financial ramifications to both the system and patients due to frequent referrals to the specialists.

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Section: Discussionmentioning

confidence: 99%

Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries

Pekez-Pavliško¹,

Račić

Kusmuk

2017

Front. Public Health

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“…The complete survey described eight case vignettes where oldest-old male or female patients presented for a routine control (Additional file 1 in [11]). These patients had no symptoms suggesting hypertension and took no antihypertensive medication.…”

Section: Methodsmentioning

confidence: 99%

“…We conducted a re-analysis of data from the cross-sectional case-vignettes study called 'Antihypertensive TreaTmENT In Very Elderly' (ATTENTIVE) [11].…”

Section: Designmentioning

confidence: 99%

“…The design of the ATTENTIVE Study has been described previously [11,12]. In brief, we organized a network of 'national coordinators' (mostly one per country) through GP organizations like the European General Practice Research Network (EGPRN).…”

Section: Settingmentioning

confidence: 99%

“…While guideline use seems to have little or no effect on treatment decisions in frail oldest-old, frailty, systolic blood pressure and history of cardiovascular disease have [11]. In addition, country-specific factors such as cardiovascular burden and life expectancy are associated with the decisions when managing hypertension in this age group [12].…”

Section: Clinical Context and Comparison With Existing Literaturementioning

confidence: 99%

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Managing hypertension in frail oldest-old – the role of guideline use by general practitioners from 29 countries

Roulet

Rozsnyai

Jungo

et al. 2019

Preprint

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Background The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear while lacking guidelines providing specific recommendations.Aim, Objectives To investigate guideline use in general practitioners (GPs) and if guideline use relates to different decisions when managing hypertension in frail oldest-old.Design/Setting Cross-sectional study.Methods GPs participated in a survey with case-vignettes of frail oldest-old varying in systolic blood pressure (SBP) and cardiovascular disease (CVD). GPs in Europe, Brazil, Israel and New Zealand were invited. We compared the percentage of GPs using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GP’s gender, years of experience and prevalence of oldest-old in their practice), we used a mixed-effects regression model accounting for clustering within countries.Results Overall, 2,543 GPs from 29 countries were included. About 60% reported to use guidelines. Higher guideline use was found in female (p=0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in guidelines use, ranging from 25% to 90% of the GPs. However, there was no difference in decisions about treatment hypertension in frail oldest-old patients between GPs that used or not used guidelines nor which guideline they used.Conclusion Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.

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Patient Characteristics and General Practitioners’ Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

et al. 2019

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Background Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence general practitioners’ (GPs) advice to stop statins in oldest-old patients. Objective To investigate the influence of a history of CVD , statin-related side effects, frailty and short life expectancy , on GPs’ advice to stop statins in oldest-old patients. Design We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment. Main Measures Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (OR adj ) were calculated for GPs’ advice to stop. Key Results Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45–47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89–90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (OR adj 13.8, 95%CI 12.6–15.1), with side effects compared to without OR adj 1.62 (95%CI 1.5–1.7) and with frailty (OR adj 4.1, 95%CI 3.8–4.4) compared to without. Shortened life expectancy increased advice to stop (OR adj 50.7, 95%CI 45.5–56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19–42) to 98% (95% CI 96–99). Conclusions The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs’ advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs’ advice to stop statins. Electronic supplementary material The online version of this article (10.1007/s11606-018-4795-x) contains supplementary material, which is available to authorized users.

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Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries

Cited by 29 publications

References 20 publications

Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries

Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries

Managing hypertension in frail oldest-old – the role of guideline use by general practitioners from 29 countries

Patient Characteristics and General Practitioners’ Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

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