Patients' perspectives on facilitators to deprescribing medications in older patients in Sweden – a questionnaire study

Naldy Parodi López, Hans Thulesius, Stina Mannheimer, Katharina T. Jungo, Kristie R. Weir, Zsofia Rozsnyai, Sven Streit, Renata Vidonscky Lüthold

Keywords: deprescribing, older patients, polypharmacy, primary care

Background:

Older patients are often treated with multiple medications simultaneously (polypharmacy), increasing the risk of side effects, interactions, and hospitalizations. Deprescribing involves identifying, discontinuing, reducing, substituting or tapering medications where potential harms outweigh potential benefits. It is feasible, generally safe, and may improve clinical outcomes. However, patients’ barriers may exist. The aim of this study was to explore older patients´ perspectives on factors that facilitate deprescribing.

Research questions:

What would help older patients with polypharmacy to stop or reduce the dose of a medication?

Method:

This project builds on a cohort of patients from a previous cross-sectional study investigating older patients’ attitudes towards deprescribing in 14 countries. Patients ≥ 65 years and regularly taking ≥5 medications were consecutively recruited through their General Practitioner (GP). An anonymous questionnaire was administered to each patient. This descriptive analysis concerns the Swedish cohort and investigates two questions: “Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?”, and “What would help you to stop or reduce the dose of a medication?”. Chi-square test was used for comparisons.

Results:

In all, 27 (27%) out of 101 patients wanted to deprescribe medications. The support of GPs was the most common help for patients in case of deprescribing (n=69, 68%), followed by plan/instructions for deprescribing (n=38, 38%), restart the medicine if necessary (n=23, 23%), use of an alternative medication (n=22, 22%), lifestyle change/physiotherapy (n=11, 11%), other (n=4, 1%). Being willing to restart the medicine if necessary was more common in those wanting deprescribing: 11 (41%) versus 12 (16%) patients (P=0.009).

Conclusions:

Almost three out of four older primary care patients with polypharmacy identified their GP as the most important source of assistance during deprescribing. This highlights the importance of the GP-patient relationship in improving pharmacotherapy.

Points for discussion:

How can the patient’s perspective contribute to the development of deprescribing interventions in primary care?

How to enhance the GP-patient relationship in settings with low continuity of care?

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