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Article Dans Une Revue BMC Geriatrics Année : 2021

General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

1 UNIBE - Universität Bern / University of Bern
2 University of Ioannina
3 Sts. Cyril and Methodius University
4 AöR - University Hospital Essen
5 University of Bonn Medical Centre [Bonn]
6 Keele University [Keele]
7 ICGP - Irish College of General Practitioners [Dublin, Irlande]
8 Hospital Israelita Albert Einstein [São Paulo, Brazil]
9 Wrocław Medical University
10 Skane University Hospital [Lund]
11 RSFM - Romanian Society of Family Medicine [Bucharest]
12 Linnaeus University
13 MHH - Medizinische Hochschule Hannover = Hannover Medical School
14 DCGP - Danish College of General Practitioners [Copenhagen]
15 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
16 University of Vienna [Vienna]
17 UA - University of Antwerp
18 University of Tartu
19 University of Ljubljana
20 Leipzig University / Universität Leipzig
21 SSLMG - Societé Scientifique Luxembourgois en Medicine generale [Luxembourg City]
22 LUMC - Leiden University Medical Center
23 Semmelweis University [Budapest]
24 Faculty of Medicine in Hradec Kralove [Republique Tchèque]
25 TAU - Tel Aviv University
26 Faculty of Medicine [Plovdiv, Bulgarie]
27 University of Luxembourg [Luxembourg]
28 NMS - NOVA Medical School - Faculdade de Ciências Médicas
29 SU - Sorbonne Université
30 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
31 HEGP - Hôpital Européen Georges Pompidou [APHP]
32 Univerzitet u Tuzli [Tuzla, Bosnie-Herzégovine]
33 RSU - Riga Stradins University
34 University of Tampere [Finland]
35 Dom zdravlja Zagreb - Centar [Zagreb]
36 SNMAPE - Shupyk National Medical Academy of Postgraduate Education [Kiev]
37 University of South Australia [Adelaide]
38 Dalhousie University [Halifax]
Liina Pilv
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Résumé

Background: General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. Methods: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. Results: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). Interpretation: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
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inserm-03311947 , version 1 (02-08-2021)

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Katharina Tabea Jungo, Sophie Mantelli, Zsofia Rozsnyai, Aristea Missiou, Biljana Gerasimovska Kitanovska, et al.. General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatrics, 2021, 21 (1), pp.19. ⟨10.1186/s12877-020-01953-6⟩. ⟨inserm-03311947⟩
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