Evidence map›Paper›PMID 34001537›Full record

ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2021

GPs' mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice.

Karolina Kuberska, Fiona Scheibl, Carol Sinnott, James P Sheppard, Mark Lown, Marney Williams, Rupert A Payne, Jonathan Mant, Richard J McManus, Jenni Burt

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

Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
0.4field-weighted citation impact, top 40% 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

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 12 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
  6. Article
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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

10 authors at 5 institutions in 1 country.

Karolina KuberskaNational Institute for Health Research senior clinical lecturer in general practice.
Fiona ScheiblNorwich Medical School, University of East Anglia, Norwich.
Carol SinnottNational Institute for Health Research senior clinical lecturer in general practice.
James P SheppardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Mark LownPrimary Care Research Group, University of Southampton, Southampton.
Marney WilliamsPatient and public involvement representative, London.
Rupert A PayneCentre for Academic Primary Care, University of Bristol, Bristol.
Jonathan MantDepartment of Public Health and Primary Care, University of Cambridge, Cambridge.
Richard J McManusNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Jenni BurtThe Healthcare Improvement Studies Institute (THIS), University of Cambridge, Cambridge.
National Institute for Health Research · GBUniversity of Oxford · GBUniversity of Bristol · GBUniversity of Cambridge · GBUniversity of East Anglia · GB

Funding

Wellcome Trust 211182/Z/18/Z
6 · The paper itself

Abstract

backgroundOptimal management of hypertension in older patients with multimorbidity is a cornerstone of primary care practice. Despite emphasis on personalised approaches to treatment in older patients, there is little guidance on how to achieve medication reduction when GPs are concerned that possible risks outweigh potential benefits of treatment. Mindlines - tacit, internalised guidelines developed over time from multiple sources - may be of particular importance in such situations.

aimTo explore GPs' decision-making on deprescribing antihypertensives in patients with multimorbidity aged ≥80 years, drawing on the concept of mindlines. DESIGN AND

settingQualitative interview study set in English general practice.

methodThematic analysis of face-to-face interviews with a sample of 15 GPs from seven practices in the East of England, using a chart-stimulated recall approach to explore approaches to treatment for older patients with multimorbidity with hypertension.

resultsGPs are typically confident making decisions to deprescribe antihypertensive medication in older patients with multimorbidity when prompted by a trigger, such as a fall or adverse drug event. GPs are less confident to attempt deprescribing in response to generalised concerns about polypharmacy, and work hard to make sense of multiple sources (including available evidence, shared experiential knowledge, and non-clinical factors) to guide decision-making.

conclusionIn the absence of a clear evidence base on when and how to attempt medication reduction in response to concerns about polypharmacy, GPs develop 'mindlines' over time through practicebased experience. These tacit approaches to making complex decisions are critical to developing confidence to attempt deprescribing and may be strengthened through reflective practice.

Indexed as

DeprescriptionsGeneral PracticeAgedAntihypertensive AgentsHumansMultimorbidityPolypharmacyQualitative ResearchAntihypertensive Agentsaged, 80 and overdeprescriptionsgeneral practicehypertensionpolypharmacyqualitative research

Identifiers

PMID34001537
PMCPMC8249009
OpenAlexW3115324054

What OpenQuestion holds

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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.