Evidence map›Paper›PMID 31088397›Full record

ArticleBMC family practice2019

Barriers and enablers for deprescribing among older, multimorbid patients with polypharmacy: an explorative study from Switzerland.

Stefan Zechmann, Cosima Trueb, Fabio Valeri, Sven Streit, Oliver Senn, Stefan Neuner-Jehle

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In one paragraph

Article in BMC family practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 2 pooled it
–field-weighted citation impact
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

31 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  19. Current Landscape and Future Directions of Deprescribing and Polypharmacy Practices in Jordan.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2024
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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

6 authors.

Stefan ZechmannInstitute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland. stefan.zechmann@usz.ch.ORCID 0000-0001-5012-0068
Cosima TruebInstitute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
Fabio ValeriInstitute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
Sven StreitInstitute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
Oliver SennInstitute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
Stefan Neuner-JehleInstitute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPolypharmacy is an increasing problem, leading to increased morbidity and mortality, especially in older, multimorbid patients. Consequently, there is a need for reduction of polypharmacy. The aim of this study was to explore attitudes, beliefs, and concerns towards deprescribing among older, multimorbid patients with polypharmacy who chose not to pursue at least one of their GP's offers to deprescribe.

methodsExploratory study using telephone interviews among patients of a cluster-randomized study in Northern Switzerland. The interview included a qualitative part consisting of questions in five pre-defined key areas of attitudes, beliefs, and concerns about deprescribing and an open explorative question. The quantitative part consisted of a rating of pre-defined statements in these areas.

resultsTwenty-two of 87 older, multimorbid patients with polypharmacy, to whom their GP offered a drug change, did not pursue all offers. Nineteen of these 22 were interviewed by telephone. The 19 patients were on average 76.9 (SD 10.0) years old, 74% female, and took 8.9 (SD 2.6) drugs per day. Drugs for acid-related disorders, analgesics and anti-inflammatory drugs were the three most common drug groups where patient involvement and the shared-decision-making (SDM) process led to the joint decision to not pursue the GPs offer. Eighteen of 19 patients fully trusted their GP, 17 of 19 participated in SDM even before this study and 8 of 19 perceived polypharmacy as a substantial burden. Conservatism/inertia and fragmented medical care were the main barriers towards deprescribing. No patient felt devalued as a consequence of the deprescribing offer. Our exploratory findings were supported by patients' ratings of predefined statements.

conclusionWe identified patient involvement in deprescribing and coordination of care as key issues for deprescribing among older multimorbid patients with polypharmacy. GPs concerns regarding patients' devaluation should not prevent them from actively discussing the reduction of drugs.

trial registrationISRCTN16560559 .

Indexed as

Attitude to HealthDecision Making, SharedDeprescriptionsPolypharmacyAgedAged, 80 and overFemaleHumansMaleMultimorbidityMultiple Chronic ConditionsSwitzerlandAnd relationshipConservatismDevaluationPatient involvementThe burden of treatmentTrust

Identifiers

PMID31088397
PMCPMC6518702

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Registered trials

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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.