Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

被引:143
|
作者
Reeve, Emily [1 ,2 ,3 ,4 ]
Wolff, Jennifer L. [5 ,6 ]
Skehan, Maureen [5 ]
Bayliss, Elizabeth A. [7 ,8 ]
Hilmer, Sarah N. [1 ,9 ,10 ]
Boyd, Cynthia M. [5 ,6 ]
机构
[1] Univ Sydney, Cognit Decline Partnership Ctr, Kolling Inst Med Res, Natl Hlth & Med Res Council,Fac Med & Hlth, Sydney, NSW, Australia
[2] Dalhousie Univ, Geriatr Med Res, Halifax, NS, Canada
[3] Nova Scotia Hlth Author, Halifax, NS, Canada
[4] Dalhousie Univ, Coll Pharm, Halifax, NS, Canada
[5] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA
[6] Johns Hopkins Univ, Sch Med, Ctr Transformat Geriatr Res, Div Geriatr Med & Gerontol, Baltimore, MD USA
[7] Kaiser Permanente Colorado, Inst Hlth Res, Aurora, CO USA
[8] Univ Colorado, Sch Med, Dept Family Med, Aurora, CO USA
[9] Royal North Shore Hosp, Dept Clin Pharmacol, St Leonards, NSW, Australia
[10] Royal North Shore Hosp, Dept Aged Care, St Leonards, NSW, Australia
基金
美国国家卫生研究院; 英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;
关键词
POTENTIALLY INAPPROPRIATE MEDICATION; PEOPLES ATTITUDES; ADULTS; POLYPHARMACY; CARE; PRESCRIPTION; WILLINGNESS; PREFERENCES; MEDICINES; DISEASES;
D O I
10.1001/jamainternmed.2018.4720
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Use of harmful and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance to discontinuing medication use is a significant barrier to deprescribing. OBJECTIVE To describe the attitudes of older adults toward deprescribing and to determine whether individual characteristics are associated with these attitudes. DESIGN, SETTING, AND PARTICIPANTS For this population-based survey study of US Medicare beneficiaries 65 years and older, data were obtained from the Medication Attitudes module fielded through in-person interviews in round 6 of the National Health and Aging Trends Study (weighted response rate of round 6 was 88.5%). The questions in this module were drawn from the Patients' Attitudes Towards Deprescribing questionnaire and its revised version. The Medication Attitudes module was fielded to a random one-third (n = 2124) of the National Health and Aging Trends Study participants (weighted response rate of this module was 94.8%). MAIN OUTCOMES AND MEASURES Responses to 2 statements ("If my doctor said it was possible, I would be willing to stop one or more of my regular medicines" and "I would like to reduce the number of medicines I amtaking") were the main outcomes of interest. RESULTS Of the 1981 Medicare beneficiaries included in the study, 1149 (55.2%, weighted) were women, and the majority (n = 715 [54.6%, weighted]) were 65 to 74 years old. A total of 1752 (92.0%, weighted) older adults reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 1241 (66.6%, weighted) older adults wanted to reduce the number of medicines that they were taking. Older adults taking 6 or more medications had greater odds than those taking fewer than 6 medications of being willing to stop taking 1 or more of their medicines (adjusted odds ratio, 2.90; 95% CI, 1.74-4.82) and wanting to reduce the number of medicines that they were taking (adjusted odds ratio, 2.31; 95% CI, 1.71-3.13). CONCLUSIONS AND RELEVANCE Physicians considering deprescribing as part of comprehensive, patient-centered care should be reassured that a majority of older Americans are open to having 1 or more of their medicines deprescribed if their physician says it is possible, and more than two-thirds want to reduce the number of medicines that they are taking.
引用
收藏
页码:1673 / 1680
页数:8
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