Background–Polypharmacy is associated with adverse effects. One solution is deprescribing, which is intentional medication discontinuation. We characterized patient characteristics, attitudes and healthcare experiences... [ view full abstract ]
Background–Polypharmacy is associated with adverse effects. One solution is deprescribing, which is intentional medication discontinuation. We characterized patient characteristics, attitudes and healthcare experiences associated with prior discontinuation. We also determined patients’ comfort with different providers recommending discontinuation.
Methods–We randomly sampled 1600 Veterans receiving Veterans Affairs primary care nationally with >5 concurrent prescribed medications and surveyed them using the Patient Perceptions of Discontinuation (PPoD) instrument. The first primary outcome was response to: “Have you ever stopped taking a medicine (with or without your doctor’s knowledge)?” Multivariable logistic modeling associated patient factors (attitudes, demographics, and healthcare experiences) with prior discontinuation. Our second primary outcome combined two yes/no questions: 1) “Imagine that a specialist…prescribed a medicine for you. Would you be comfortable if your PCP told you to stop taking it?” and 2) “Imagine that your VA PCP prescribed a medicine for you. Would you be comfortable if a VA clinical pharmacist told you to stop taking it?” Multinomial regression modeling associated patient factors with patterns of responses.
Results–Respondents (n=803; adjusted response rate, 52%), were predominantly male (85%) and age > 65 years (60%). 34% of patients reported previously stopping medicine. In a multivariable logistic regression model (p<0.001, pseudo-R2 0.31), factors associated with discontinuation included being told to stop or asking to stop a medicine, greater interest in deprescribing and in shared-decision making, and higher education. With respect to patients’ comfort, 38% of respondents did not want their PCP to stop a specialist’s medicine, nor would they want a pharmacist to stop a PCP’s medicine.
Discussion–This study suggests that more highly educated patients with interest in deprescribing and in shared-decision making may be more receptive to discontinuation discussions. Patients also vary in whom they trust to deprescribe, which is important to understand as multidisciplinary models of care expand.
Prevalence and drivers of overuse , Shared decision making and patient-reported outcomes
