ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2019
GPs' management of polypharmacy and therapeutic dilemma in patients with multimorbidity: a cross-sectional survey of GPs in France.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- A conceptual model of factors potentially influencing prescribing decisions for chronic conditions: an overview of systematic reviews.BMC medicine · 2025Pooled it
- Understanding "Alert Fatigue" in Primary Care: Qualitative Systematic Review of General Practitioners Attitudes and Experiences of Clinical Alerts, Prompts, and Reminders.Journal of medical Internet research · 2025Pooled it
- Understanding GPs' clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research.International journal of clinical practice · 2021Pooled it
- Patterns of Care in the Final Week of Life: A Comparative Analysis of Aggressive Treatment Versus Comfort-Centered Care Across Healthcare Settings.Medicina (Kaunas, Lithuania) · 2026Article
- Instruments for assessing healthcare professionals' knowledge, attitudes and practices regarding deprescribing: a scoping review.International journal of clinical pharmacy · 2026Review
- Attitudes and confidence toward deprescribing: a survey among Italian general practitioners.BMC primary care · 2025Observational
- Description of barriers to the deprescription of inappropriate drugs in French hospitalized geriatric services.Scientific reports · 2025Article
- Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review.BMJ open · 2024Article
- Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review.npj aging · 2024Review
- Article
- Integrating frailty interventions into existing care models: a comprehensive approach to enhancing patient outcomes in chronic disease management.Frontiers in public health · 2024Review
- Prevalence and correlates of multimorbidity among patients attending AYUSH primary care settings in Delhi-National Capital Region, India.BMC complementary medicine and therapies · 2023Article
- Development of a shared decision-making intervention to improve drug safety and to reduce polypharmacy in frail elderly patients living at home.PEC innovation · 2022Article
- Factors which influence the deprescribing decisions of community-living older adults and GPs in Australia.Health & social care in the community · 2022Article
- Association between recorded medication reviews in primary care and adequate drug treatment management - a cross-sectional study.Scandinavian journal of primary health care · 2021Article
- 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 · 2021Article
- Potentially inappropriate prescribing in older adults in Mexico.Revista de saude publica · 2021Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGPs are confronted with therapeutic dilemmas in treating patients with multimorbidity and/or polypharmacy when unfavourable medication risk-benefit ratios (RBRs) conflict with patients' demands.
aimTo understand GPs' attitudes about prescribing and/or deprescribing medicines for patients with multimorbidity and/or polypharmacy, and factors associated with their decisions. DESIGN AND
settingCross-sectional survey in 2016 among a national panel of 1266 randomly selected GPs in private practice in France.
methodGPs' opinions and attitudes were explored using a standardised questionnaire including a case vignette about a female treated for multiple somatic diseases, sleeping disorders, and chronic pain. Participants were randomly assigned one of eight versions of this case vignette, varying by patient age, socioprofessional status, and stroke history. Backward selection was used to identify factors associated with GPs' decisions about drugs they considered inappropriate.
resultsNearly all (91.4%) responders felt comfortable or fairly comfortable deprescribing inappropriate medications, but only 34.7% decided to do so often or very often. In the clinical vignette, most GPs chose to discontinue symptomatic medications (for example, benzodiazepine, paracetamol/tramadol) because of unfavourable RBRs. When patients asked for ketoprofen for persistent sciatica, 94.1% considered this prescription risky, but 25.6% would prescribe it. They were less likely to prescribe it to older patients (adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] = 0.36 to 0.63), or those with a stroke history (AOR 0.55, 95% CI = 0.42 to 0.72).
conclusionIn therapeutic dilemmas, some GPs choose to prioritise patients' requests over iatrogenic risks. GPs need pragmatic implementation tools for handling therapeutic dilemmas, and to improve their skills in medication management and patient engagement in such situations.
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Registered trials
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.