Effects of warning information at medication initiation on deprescribing intentions in older adults: A hypothetical vignette

Patient Education and Counseling, Год журнала: 2025, Номер 133, С. 108654 - 108654

Опубликована: Янв. 11, 2025

Язык: Английский

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Latent class analysis identifies four distinct Patient Deprescribing Typologies among older adults in four countries

Innovation in Aging, Год журнала: 2025, Номер 9(2)

Опубликована: Янв. 1, 2025

Polypharmacy, the concurrent use of multiple medicines, is a growing concern among older adults and those with chronic conditions. Deprescribing through dose reduction or discontinuing selected medicines strategy for reducing medicine-related harm. The Patient Typology was developed using qualitative methods to describe varying factors that are important when they consider deprescribing. objective this study quantitative define distinct classes via Typology. This used cross-sectional experimental design in which data collected an online survey from participants 65 years Australia, Netherlands, United Kingdom, States. A latent class analysis performed 4-item about beliefs importance how learn medicine decision-making preferences, attitudes towards stopping medicines. Older (n = 2,250) were median 70 2-thirds reported their highest level education associate's degree trade school less. We identified 4 classes: Class 1 "Trusts doctor" (41.6%), 2 "Makes own decisions" (30.2%), 3 "Avoids deprescribing" (15.5%), 'Medicines not important' (12.7%). report diverse perspectives deprescribing, emphasizing need tailored communication strategies clinical settings. Additional research needed examine adults' preferences real-world contexts refine improve deprescribing interventions. NCT04676282.

Язык: Английский

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Older Adults’ Attitudes Toward Deprescribing in 14 Countries

JAMA Network Open, Год журнала: 2025, Номер 8(2), С. e2457498 - e2457498

Опубликована: Фев. 10, 2025

Importance Better understanding of patients’ attitudes toward deprescribing specific medications will inform future interventions. Objective To investigate older adults’ by investigating which they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing. Design, Setting, Participants This survey study was conducted from May 2022 December 2023 primary care settings 14 countries. Patients aged 65 years or taking 5 more were consecutively recruited their general practitioner (GP) completed questionnaire. Exposures Patient characteristics, including gender, number medications, GP education level, financial status, confidence completing medical forms, self-rated health, satisfaction trust GP, country. Main Outcomes Measures The outcomes as measured responses question, “Thinking about your current medication list, are there any that you stop reduce dose of?” Multilevel multivariable logistic regression analysis used, adjusted for clustering effect at country association between characteristics Results Of 1340 patients (mean [SD], 96 [47] per country), 736 (55%) women, 580 (44%) had secondary school highest level education, 1089 (82%) satisfied 589 expressed deprescribe 1 medications. varying levels, 79% (86 109 patients) Poland 23% (21 Bulgaria. 3 most reported deprescribed diuretics (111 1002 [11%]), lipid-modifying agents (109 acting on renin-angiotensin system (83 [8%]). odds naming least lower higher (odds ratio, 0.31; 95% CI, 0.21-0.47) 0.960; 0.930-0.998). Conclusions Relevance In this older, varied across countries, demonstrating interventions could be impactful when adapted contexts. These findings highlight importance patient-practitioner communication ensuring appropriate use.

Язык: Английский

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Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial

BMJ Open, Год журнала: 2024, Номер 14(1), С. e075325 - e075325

Опубликована: Янв. 1, 2024

Objective To investigate the association between older patients’ willingness to have one or more medications deprescribed and: (1) change in medications, (2) appropriateness of and (3) implementation prescribing recommendations generated by electronic decision support system tested ‘Optimising PharmacoTherapy In Multimorbid Elderly Primary CAre’ (OPTICA) trial. Design A longitudinal sub-study OPTICA trial, a cluster randomised controlled Setting Swiss primary care settings. Participants were aged ≥65 years, with ≥3 chronic conditions ≥5 regular recruited from 43 general practitioner (GP) practices. Exposures Patients’ was assessed using three questions ‘revised Patient Attitudes Towards Deprescribing’ (rPATD) questionnaire its concerns about stopping score. Measures/analyses Medication-related outcomes collected at 1 year follow-up. Aim outcome: number long-term baseline 12 month 2 medication (Medication Appropriateness Index). 3 binary variable on whether any recommendation during review implemented. We used multilevel linear regression analyses (aim aim 2) logistic 3). Models adjusted for sociodemographic variables clustering effect GP level. Results 298 patients completed rPATD, 45% women 78 years median age. statistically significant found score over time (per 1-unit increase average use 0.65 higher; 95% CI: 0.08 1.22). Other than that we did not find evidence associations agreement deprescribing medication-related outcomes. Conclusions an most measures patient year. Trial registration NCT03724539 .

Язык: Английский

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Investigating Older Adults’ Perceptions of AI Tools for Medication Decisions: Vignette-Based Experimental Survey

Journal of Medical Internet Research, Год журнала: 2024, Номер 26, С. e60794 - e60794

Опубликована: Дек. 16, 2024

Background Given the public release of large language models, research is needed to explore whether older adults would be receptive personalized medication advice given by artificial intelligence (AI) tools. Objective This study aims identify predictors likelihood stopping a and influence source information. Methods We conducted web-based experimental survey in which US participants aged ≥65 years were asked report their based on information using 6-point Likert scale (scale anchors: 1=not at all likely; 6=extremely likely). In total, 3 medications presented randomized order: aspirin (risk bleeding), ranitidine (cancer-causing chemical), or simvastatin (lack benefit with age). 5 sources presented: primary care provider (PCP), pharmacist, AI that connects electronic health record (EHR) provides PCP (“EHR-PCP”), EHR access directly (“EHR-Direct”), asks questions provide (“Questions-Direct”) directly. calculated descriptive statistics who extremely likely (score 6) stop used logistic regression demographic being (scores 4-6) as opposed unlikely 1-3) medication. Results Older (n=1245) reported PCP’s recommendation (n=748, 60.1% [aspirin] n=858, 68.9% [ranitidine]) compared pharmacist (n=227, 18.2% [simvastatin] n=361, 29% [ranitidine]). They infrequently when recommended (EHR-PCP: n=182, 14.6% n=289, 23.2% [ranitidine]; EHR-Direct: n=118, 9.5% n=212, 17% Questions-Direct: n=121, 9.7% n=204, 16.4% adjusted analyses, characteristics increased following an included Black African American White (Questions-Direct: odds ratio [OR] 1.28, 95% CI 1.06-1.54 EHR-PCP: OR 1.42, 1.17-1.73), having higher self-reported 1.09, 1.01-1.18 1.13 95%, 1.05-1.23), confidence 1.36, 1.16-1.58 1.55, 1.33-1.80), apps (EHR-Direct: 1.38, 1.18-1.62 1.49, 1.27-1.74). literacy less 0.81, 0.75-0.88 0.85, 0.78-0.92). Conclusions have reservations about However, individuals are American, health, may AI-based recommendations.

Язык: Английский

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Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients' Perspectives: The Diabetes and Aging Study

Journal of the American Geriatrics Society, Год журнала: 2025, Номер unknown

Опубликована: Янв. 9, 2025

ABSTRACT Background Little is known about how patients' preferences, expectations, and beliefs (jointly referred to as perspectives) influence deprescribing. We evaluated the association of self‐reported perspectives with subsequent deprescribing diabetes medications in older adults type 2 diabetes. Methods Longitudinal cohort study 1629 pharmacologically treated ages 65–100 years who received care at Kaiser Permanente Northern California (KPNC) participated Diabetes Preferences Self‐Care survey (2019). The asked questions regarding use medications. Deprescribing was identified during 24 months following defined any following: discontinuation one or more therapeutic classes, reduction frequency daily dosing, total pill count, dose for oral hypoglycemic agents. Rates measures relative risk were calculated select clinical factors. Models predicting adjusted age, sex, race/ethnicity, health literacy, baseline number medications, duration diabetes, overtreatment per Endocrine Society guidelines, KPNC eligibility targeted weighted account age‐stratified complex sampling design response. Results Six hundred seventy‐three (38%) patients experienced over a mean follow‐up 23 months. significantly associated patient perspectives: not expecting need medication life (RR = 1.48, 95% CI: 1.07–2.03) recognizing that taking fewer could lead higher blood sugar levels 1.31, 1.09–1.58). Conclusions Patients' may enable hinder deprescribing, emphasizing importance soliciting these shared decision‐making. Effective will benefit from understanding fostering patient–provider communication changes throughout disease course.

Язык: Английский

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An Educational Intervention to Promote Central Nervous System-Active Deprescribing in Dementia: A Pilot Study

Drugs & Aging, Год журнала: 2025, Номер unknown

Опубликована: Янв. 20, 2025

Язык: Английский

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Deprescribing in Palliative Care

Springer eBooks, Год журнала: 2024, Номер unknown, С. 1 - 25

Опубликована: Янв. 1, 2024

Язык: Английский

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Improving the feasibility of deprescribing proton pump inhibitors: GPs’ insights on barriers, facilitators, and strategies

Frontiers in Pharmacology, Год журнала: 2024, Номер 15

Опубликована: Сен. 20, 2024

Introduction The prevalent overprescribing of proton pump inhibitors (PPIs) poses health risks from prolonged use. GPs play a key role in initiating deprescribing PPIs, so understanding their decision-making factors and strategies to improve feasibility is crucial. This study aimed investigate the perspectives on PPIs with focus identifying facilitators, barriers, enhance clinical settings. Methods A qualitative involving semi-structured interviews was conducted nine or trainees. thematic analysis using NVivo R1 (2020). Results Four main categories were identified: 1) Inappropriate prescribing 2) Facilitators for 3) Barriers 4) Feasibility PPIs. acknowledged excessive often inappropriate PPI prescribing, lack efforts mainly due time constraints. Other barriers included patient reluctance, fear symptom recurrence, unawareness long-term risks. Patient-initiated request facilitator emphasized need collaboration healthcare professionals, clear guidelines, improved digital support, increased physician availability, raising awareness among providers patients feasibility. Discussion are calling multifaceted approach patient-centered approaches, systemic optimizations, support other provider-centered emphasize importance

Язык: Английский

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Deprescribing in Palliative Care

Опубликована: Янв. 1, 2024

Язык: Английский

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