Is willingness to deprescribe enough? Willingness to deprescribe and actual change in medication use over time: an analysis of trial data from older patients with polypharmacy

Katharina Tabea Jungo, Kristie Weir, Damien Cateau, Sven Streit

Keywords: deprescribing, older adults, multimorbidity, polypharmacy

Background:

There is a lack of evidence on whether patients’ willingness to have medications deprescribed (i.e., discontinued or reduced) is associated with actual changes in medication use and medication appropriateness over time.

Research questions:

Is there an association between older patients' willingness to have medication(s) deprescribed and actual changes in medication use or medication appropriateness?

Method:

Data from the OPTICA trial were used. Patients were ≥65 years, with ≥3 chronic conditions, and ≥5 medications. Patients’ were asked about their willingness to have medications deprescribed using the validated ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire. Medication appropriateness was measured using the Medication Appropriateness Index (MAI). Multilevel regression analyses adjusted for patient sociodemographic variables and clustering at general practitioner level were used to investigate the association between patients’ baseline willingness to deprescribe and medication data (at 1-year follow-up).

Results:

298 patients completed the rPATD questionnaire. 45% were women and the average age was 79 (standard deviation=7). 88% of participants agreed or strongly agreed with the statement “If my doctor said it was possible, I would be willing to stop one or more of my regular medicines”. We did not find any statistically significant association between older patients' willingness to have medications deprescribed and change in the number of medications or change in medication appropriateness during the 1-year follow-up period. Sensitivity analyses using other questions from the rPATD and the concerns about stopping score showed similar results.

Conclusions:

We did not find any association between patients’ willingness to deprescribe, and changes to their medication use or medication appropriateness over time. Our results could be explained by patients’ willingness to deprescribe hypothetically may not adequately reflect a patients’ real willingness to have specific medications deprescribed, or patients being willing to change different medication(s) than those suggested by their physicians or the clinical decision support system tested in the trial.

Points for discussion:

What are other predictors of deprescribing uptake?

How can we translate patients’ hypothetical willingness to have medications deprescribed into actual changes in medication use?

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