Attitudes and beliefs of patients and primary caregivers towards deprescribing in a tertiary health care facility

Main Article Content

Keywords

Deprescriptions, Inappropriate Prescribing, Attitude, Personal Satisfaction, Health Knowledge, Attitudes, Practice, Patients, Caregivers, Surveys and Questionnaires, Cross-Sectional Studies, India

Abstract

Background: Good prescribing practices form the essence of drug therapy for better patient care. The major aim of better prescribing is to improve rational prescribing. Deprescribing gained momentum in recent decades.


Objective: This study aimed to explore the attitude and beliefs of deprescribing among patients and their caregivers forming dyads in a tertiary health care facility.


Methods: Cross-sectional, questionnaire-based prospective study done for two months. Attitude towards deprescribing was assessed by using validated rPATD (revised Patient attitude towards deprescribing) questionnaire. Cohen's kappa coefficient was used to measure the agreement between the views of people and their caregivers forming dyads about medication cessation.


Results: 312 patients and caregivers (156 forming dyads) participated in the study. Among 156 patients, 25.6% were hypertensives & 21.2% had diabetes. 41.7% were between 36-50 years of age. Only 16.7% belong to the elderly age group. 2.5% were taking >5 medications. 43.6% of patients and 62.2% of caregivers were female. 51.3% of the patients were willing to stop one or more of their regular medicine(s) under the treating physician's advice, but 62% were satisfied with their current medicine(s). 33.4% were reluctant to stop taking medicines for a long time.


Conclusions: In our study, more than 50% of people and their caregivers were willing to try medication cessation under their physician's recommendation. There was moderate agreement between patients and their caregivers in the trial of medication cessation. Thus, the results obtained from this study may help towards improving rationalized prescribing practices in the institutional setup.

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References

1. Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S. Prescribing patterns and predictors of high-level polypharmacy in the elderly population: A prospective surveillance study from two teaching hospitals in India. Am J Geriatr Pharmacother. 2010;8(3):271-280. https://doi.org/10.1016/j.amjopharm.2010.06.004
2. Jetha S. Polypharmacy, the Elderly, and Deprescribing. Consult Pharm. 2015;30(9):527-532. https://doi.org/10.4140/tcp.n.2015.527
3. Corsonello A, Pranno L, Garasto S, Fabietti P, Bustacchini S, Lattanzio F. Potentially inappropriate medication in elderly hospitalized patients. Drugs Aging. 2009;26(Suppl 1):31-39. https://doi.org/10.2165/11534640-000000000-00000
4. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. https://doi.org/10.1517/14740338.2013.827660
5. Shah KN, Joshi HM, Christian RP, Patel KP, Malhotra SD. Prevalence of potentially inappropriate medications and prescription cost analysis among older cardiac patients in an outpatient department of a tertiary care hospital in India. J Basic Clin Pharm. 2016;7(4):110-115. https://doi.org/10.4103/0976-0105.189434
6. Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31-32):543-551. https://doi.org/10.3238/arztebl.2010.0543
7. Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of 'deprescribing' with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254-1268. https://doi.org/10.1111/bcp.12732
8. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827-834. https://doi.org/10.1001/jamainternmed.2015.0324
9. Sweta K, Bhat D, Saraswathy GR, Maheswari E. The Views of Indian Practitioners on Deprescribing. J Gen Intern Med. 2019;34(6):828-830. https://doi.org/10.1007/s11606-018-4808-9
10. Scott IA, Gray LC, Martin JH, Mitchell CA. Minimizing inappropriate medications in older populations: a 10-step conceptual framework. Am J Med. 2012;125(6):529-537. https://doi.org/10.1016/j.amjmed.2011.09.021
11. Griebling TL. Re: Factors Influencing Deprescribing Habits among Geriatricians. J Urol. 2016;195(3):669. https://doi.org/10.1016/j.juro.2015.12.059
12. Sivagnanam G. Deprescription: The prescription metabolism. J Pharmacol Pharmacother. 2016;7(3):133-137. https://doi.org/10.4103/0976-500x.189680
13. Paque K, Vander Stichele R, Elseviers M, et al. Barriers and enablers to deprescribing in people with a life-limiting disease: A systematic review. Palliat Med. 2019;33(1):37-48. https://doi.org/10.1177/0269216318801124
14. Chou J, Tong M, Brandt NJ. Combating Polypharmacy Through Deprescribing Potentially Inappropriate Medications. J Gerontol Nurs. 2019;45(1):9-15. https://doi.org/10.3928/00989134-20190102-01
15. Kuhn-Thiel AM, Weiß C, Wehling M; FORTA authors/expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31(2):131-140. https://doi.org/10.1007/s40266-013-0146-0
16. Barry PJ, O'Keefe N, O'Connor KA, O'Mahony D. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients. J Clin Pharm Ther. 2006;31(6):617-626. https://doi.org/10.1111/j.1365-2710.2006.00783.x
17. Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People's attitudes, beliefs, and experiences regarding polypharmacy and willingness to Deprescribe. J Am Geriatr Soc. 2013;61(9):1508-1514. https://doi.org/10.1111/jgs.12418
18. Blanco JR, Morillo R, Abril V, et al. Deprescribing of non-antiretroviral therapy in HIV-infected patients. Eur J Clin Pharmacol. 2020;76(3):305-318. https://doi.org/10.1007/s00228-019-02785-z
19. Reeve E, Bell JS, Hilmer SN. Barriers to Optimising Prescribing and Deprescribing in Older Adults with Dementia: A Narrative Review. Curr Clin Pharmacol. 2015;10(3):168-177. https://doi.org/10.2174/157488471003150820150330
20. Reeve E, Low LF, Shakib S, Hilmer SN. Development and Validation of the Revised Patients' Attitudes Towards Deprescribing (rPATD) Questionnaire: Versions for Older Adults and Caregivers. Drugs Aging. 2016;33(12):913-928. https://doi.org/10.1007/s40266-016-0410-1
21. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648-1654. https://doi.org/10.1001/archinternmed.2010.355
22. Hortal Carmona J, Aguilar Cruz I, Parrilla Ruiz F. Un modelo de deprescripción prudente [A prudent deprescription model]. Med Clin (Barc). 2015;144(8):362-369. https://doi.org/10.1016/j.medcli.2014.02.026
23. Trenaman S, Willison M, Robinson B, Andrew M. A collaborative intervention for deprescribing: The role of stakeholder and patient engagement. Res Social Adm Pharm. 2020;16(4):595-598. https://doi.org/10.1016/j.sapharm.2019.07.004
24. Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States. JAMA Intern Med. 2018;178(12):1673-1680. https://doi.org/10.1001/jamainternmed.2018.4720
25. Shrestha S, Giri R, Sapkota HP, et al. Attitudes of ambulatory care older Nepalese patients towards deprescribing and predictors of their willingness to deprescribe. Ther Adv Drug Saf. 2021;12:20420986211019309. https://doi.org/10.1177/20420986211019309
26. Portman D. De-prescription. Fam Syst Health. 2017;35(3):389-390. https://doi.org/10.1037/fsh0000292
27. Turner JP, Edwards S, Stanners M, Shakib S, Bell JS. What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals. BMJ Open. 2016;6(3):e009781. https://doi.org/10.1136/bmjopen-2015-009781
28. Mishori R. What Needs to Change to Make Deprescribing Doable. Fam Pract Manag. 2018;25(3):5-6.
29. Shrestha S, Poudel A, Steadman K, Nissen L. Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: A systematic review. Br J Clin Pharmacol. 2020;86(10):1931-1945. https://doi.org/10.1111/bcp.14113
30. Kua KP, Saw PS, Lee SWH. Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia: a cross-sectional questionnaire study. Int J Clin Pharm. 2019;41(3):793-803. https://doi.org/10.1007/s11096-019-00829-z
31. Williams ME, Pulliam CC, Hunter R, et al. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people. J Am Geriatr Soc. 2004;52(1):93-98. https://doi.org/10.1111/j.1532-5415.2004.52016.x
32. Espeland MA, Whelton PK, Kostis JB, et al. Predictors and mediators of successful long-term withdrawal from antihypertensive medications. TONE Cooperative Research Group. Trial of Nonpharmacologic Interventions in the Elderly. Arch Fam Med. 1999;8(3):228-236. https://doi.org/10.1001/archfami.8.3.228
33. Turner JP, Martin P, Zhang YZ, Tannenbaum C. Patients beliefs and attitudes towards deprescribing: Can deprescribing success be predicted?. Res Social Adm Pharm. 2020;16(4):599-604. https://doi.org/10.1016/j.sapharm.2019.07.007
34. Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. The benefits and harms of deprescribing. Med J Aust. 2014;201(7):386-389. https://doi.org/10.5694/mja13.00200
35. Martinez AI, Spencer J, Moloney M, Badour C, Reeve E, Moga DC. Attitudes toward deprescribing in a middle-aged health disparities population. Res Social Adm Pharm. 2020;16(10):1502-1507. https://doi.org/10.1016/j.sapharm.2020.02.014
36. Dharmarajan TS, Choi H, Hossain N, et al. Deprescribing as a Clinical Improvement Focus. J Am Med Dir Assoc. 2020;21(3):355-360. https://doi.org/10.1016/j.jamda.2019.08.031
37. Khairnar M, Naveen Kumar P, Kusumakar A. Updated BG prasad socioeconomic status classification for the year 2021. J Indian Assoc Public Health Dent. 2021;19:155. https://doi.org/10.4103/jiaphd.jiaphd_52_21