Attitudes towards deprescribing in patients with multimorbidity and polypharmacy in primary care

Abstract

Background: Population ageing has led to an increase in multimorbidity and polypharmacy. Some medications may need to be stopped, but patient attitudes towards deprescribing are poorly understood. This study explores attitudes towards (de)prescribing in patients with multimorbidity in the UK primary care. Methods: Patients with multimorbidity were invited to complete the Revised Patients Attitudes Towards Deprescribing (rPATD) Questionnaire using the Evergreen Life Personal Health Record App (Manchester, UK). The responses were linked to electronic health records. Anonymised data were analysed in a trusted research environment (University of Liverpool) for group comparisons and using multivariable logistic regression to identify factors associated with satisfaction with current medications. Results: A total 1,019 patients participated in the study (n=365 aged <65, 30% males; n=654 ≥65, 57% males). Most patients were satisfied with their current medications (74% aged <65, 70% aged ≥65) but were willing to stop one or more of their regular medicines if their doctor said it was possible (82%, 68% accordingly). Polypharmacy, use of antihypertensive drugs, and antidepressants were associated with patient-reported burden in taking medicines. Frailty did not influence patient deprescribing attitudes. Patients who were satisfied with current medications had fewer medications. Independent predictors of satisfaction with current medications were higher total involvement and appropriateness scores, and lower total burden score. Conclusions: Most patients with multimorbidity would consider stopping some of their medications, even when they are generally satisfied with the treatments they received. Frailty status does not imply willingness to stop medications. Clinicians should discuss medication deprescribing for shared decision.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study/project is funded by the National Institute for Health Research (NIHR) under its Programme Artificial Intelligence for Multiple and Long-Term Conditions (NIHR203986). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. IB is supported by NIHR as Senior Investigator award (NIHR205131).AW is partly funded by Health and Care Research Wales award (NHS-RTA-21-02)

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Newcastle North Tyneside Research Ethics Committee (REC reference:22/NE/0088) granted ethical approval for the DynAIRx study.

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Yes

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Data Availability

All data produced in the present study are available upon reasonable request to the authors

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