Evidence map›Paper›PMID 30314468›Full record

ArticleBMC family practice2018

How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study.

Sophie Mantelli, Katharina Tabea Jungo, Zsofia Rozsnyai, Emily Reeve, Clare H Luymes, Rosalinde K E Poortvliet, Arnaud Chiolero, Nicolas Rodondi, Jacobijn Gussekloo, Sven Streit

Open access · goldFull text read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC family practice, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 2 pooled it
2.2field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 54 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Observational
  5. Article
  6. Review
  7. Article
  8. Article
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  11. Perspectives on deprescribing in palliative care.Expert review of clinical pharmacology · 2023
    Review
  12. Differences in Factors Influencing Deprescribing between Primary Care Providers: Cross-Sectional Study.International journal of environmental research and public health · 2023
    Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. GPs' mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 4 countries.

Sophie MantelliInstitute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Katharina Tabea JungoInstitute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Zsofia RozsnyaiInstitute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Emily ReeveNHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Clare H LuymesDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Rosalinde K E PoortvlietDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Arnaud ChioleroInstitute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Nicolas RodondiInstitute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Jacobijn GusseklooDepartment of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Sven StreitInstitute of Primary Health Care Bern(BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland. sven.streit@biham.unibe.ch.ORCID 0000-0002-3813-4616
University of Bern · CHLeiden University Medical Center · NLThe University of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMany oldest-old (> 80-years) with multimorbidity and polypharmacy are at high risk of inappropriate use of medication, but we know little about whether and how GPs would deprescribe, especially in the frail oldest-old. We aimed to determine whether, how, and why Swiss GPs deprescribe for this population.

methodsGPs took an online survey that presented case-vignettes of a frail oldest-old patient with and without history of cardiovascular disease (CVD) and asked if they would deprescribe any of seven medications. We calculated percentages of GPs willing to deprescribe at least one medication in the case with CVD and compared these with the case without CVD using paired t-tests. We also included open-ended questions to capture reasons for deprescribing and asked which factors could influence their decision to deprescribe by asking for their agreement on a 5-point-Likert-scale.

resultsOf the 282 GPs we invited, 157 (56%) responded: 73% were men; mean age was 56. In the case-vignette without CVD, 98% of GPs deprescribed at least one medication (usually cardiovascular preventive medications) stating it had no indication nor benefit. They would lower the dose or prescribe pain medication as needed to reduce side effects. Their response was much the same when the patient had a history of CVD. GPs reported they were influenced by 'risk' and 'benefit' of medications, 'quality of life', and 'life expectancy', and prioritized the patient's wishes and priorities when deprescribing.

conclusionSwiss GPs were willing to deprescribe cardiovascular preventive medication when it lacked indication but tended to retain pain medication. Developing tools for GPs to assist them in balancing the risks and benefits of medication in the context of patient values may improve deprescribing activities in practice.

Indexed as

DeprescriptionsGeneral PractitionersPolypharmacyAged, 80 and overAnalgesicsAntihypertensive AgentsCardiovascular AgentsCardiovascular DiseasesFemaleFrail ElderlyHumansHydroxymethylglutaryl-CoA Reductase InhibitorsLife ExpectancyMaleMiddle AgedPainAnalgesicsAntihypertensive AgentsCardiovascular AgentsHydroxymethylglutaryl-CoA Reductase InhibitorsPlatelet Aggregation InhibitorsComplexityDeprescribingFrailtyMultimorbidityOld agePolypharmacy

Identifiers

PMID30314468
PMCPMC6186124
OpenAlexW2897324465

What OpenQuestion holds

Textfull text, public
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.