Postdoctoral Fellow Brigham and Women's Hospital and Harvard Medical School Boston, United States
Background: Understanding if and how patients’ willingness to have their medications deprescribed (i.e., discontinued or reduced) is associated with medication-related outcomes over time is crucial for the successful implementation of recommendations to optimize medication use.
Objectives: To investigate the association between older patients' willingness to have one or more medications deprescribed and: (1) actual change in patients' medications at 1-year follow-up, (2) change in the appropriateness of medications at 1-year follow-up, and (3) actual implementation of prescribing recommendations generated by the electronic decision support system tested in the OPTICA trial.
Methods: The proposed project is a longitudinal sub-study of the ‘Optimizing PharmacoTherapy In the Multimorbid Elderly in Primary CAre’ (OPTICA) trial, a cluster randomized controlled trial, which took place in Swiss primary care settings. Trial participants were patients aged ≥65 years and over, with ≥3 chronic conditions, and ≥5 regular medications recruited from 43 GP practices. At baseline, patients’ willingness to have medications deprescribed was assessed using questions from the ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire and its concerns about stopping score. The data on medication-related outcomes was collected during the 1-year follow-up period. For aim 1, the outcome was change in the number of long-term medications between baseline and the 12-month follow-up. For aim 2, the outcome was change in medication appropriateness as measured by the Medication Appropriateness Index. For aim 3, the outcome was a binary variable on whether any prescribing recommendation generated during the OPTICA medication review was implemented. For aim 1 and aim 2, we used multilevel linear regression analyses. For aim 3, we used multilevel logistic regression analyses. Models were adjusted for patient sociodemographic variables, the clustering effect at the GP level and the group allocation of GPs.
Results: Of the 298 patients for whom data on the rPATD was collected at baseline, 45% were women and the median age was 78 (IQR: 74-83). Apart from the statistically significant association between the concerns about stopping score and the change in the number of medications over time (per 1-unit increase in the score the average number of medications use was 0.65 higher; 95% CI: 0.08 to 1.22), we did not find any evidence for statistically significant associations between patients’ willingness to have medications deprescribed and medication-related outcomes over time.
Conclusions: We were unable to link patients’ willingness to have medications deprescribed and medication-related outcomes over one year.
