van Middelaar Tessa, Ivens Sophie D, van Peet Petra G, Poortvliet Rosalinde K E, Richard Edo, Pols A Jeannette, Moll van Charante Eric P
Department of Neurology, Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Neurology, Academic Medical Center (AMC), Amsterdam, The Netherlands.
BMJ Open. 2018 Apr 20;8(4):e020871. doi: 10.1136/bmjopen-2017-020871.
To explore general practitioners' (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support.
Semistructured interviews.
Dutch general practice.
Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached.
GPs appeared reluctant to start AHM, especially in patient >80 years. High systolic blood pressure and history of cardiovascular disease or diabetes were enablers to start or intensify treatment. Reasons to refrain from this were frailty and patient preference. GPs described a tendency to continue AHM regimens unchanged, influenced by daily time constraints, automated prescription routines and anticipating discomfort when disturbing patients' delicate balance. GPs were only inclined to deprescribe AHM in terminally ill patients or after prolonged achievement of target levels in combination with side effects or patient preference. Deprescription was facilitated when GPs had experience with patients showing increased quality of life after deprescription and was withheld by anticipated regret (ie, GPs' fear of a stroke after deprescribing). GPs felt insufficient guidance from current guidelines, especially on deprescription.
GPs are reluctant to start or deprescribe AHM in older people and have a propensity to continue AHM within a daily routine that insufficiently supports critical medication review. (De)prescription is influenced by patient preferences and anticipated regret and current guidelines provide insufficient guidance.
探讨全科医生（GP）在老年患者中开具或停用抗高血压药物（AHM）的常规做法和考虑因素、他们对现行指南实用性的判断以及对未来支持的需求。
半结构化访谈。
荷兰全科医疗。
根据经验水平和执业特点有目的地抽取了15名全科医生，直至达到饱和状态。
全科医生似乎不愿意开始使用抗高血压药物，尤其是在80岁以上的患者中。收缩压高以及有心血管疾病或糖尿病病史是开始或强化治疗的促成因素。不这样做的原因是身体虚弱和患者偏好。全科医生描述了一种倾向，即受每日时间限制、自动化处方程序以及担心扰乱患者微妙平衡时会带来不适的影响而维持抗高血压药物治疗方案不变。全科医生仅倾向于在绝症患者中停用抗高血压药物，或在长期达到目标水平并伴有副作用或患者偏好的情况下停用。当全科医生有过患者在停用抗高血压药物后生活质量提高的经验时，停用药物会更容易，但由于预期的遗憾（即全科医生担心停用药物后患者会中风）而有所保留。全科医生认为现行指南的指导不足，尤其是在停用药物方面。
全科医生不愿意在老年人中开始或停用抗高血压药物，并且倾向于在日常工作中继续使用抗高血压药物，而日常工作对关键药物审查的支持不足。开具或停用药物受患者偏好和预期遗憾的影响，现行指南提供的指导不足。
