Djatche L, Lee S, Singer D, Hegarty S E, Lombardi M, Maio V
College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA.
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA.
J Clin Pharm Ther. 2018 Aug;43(4):550-555. doi: 10.1111/jcpt.12688. Epub 2018 Apr 22.
Deprescribing is the process of discontinuing or reducing the dosage of medications that are no longer appropriate or aligned with goals of care, which is paramount in elderly patients with multiple comorbidities and polypharmacy. The objective of this study was to assess the perceptions of primary care physicians on deprescribing for elderly patients and potential barriers to deprescribing that physicians experience in the Local Health Authority (LHA) of Parma, Emilia-Romagna, Italy.
One hundred and sixty physicians (57% of the total number of primary care physicians in Parma) attended an educational session related to deprescribing and were asked to anonymously complete a paper survey. Participants were asked to assess their level of agreement on nine questions about their perception of deprescribing and potential factors affecting the deprescribing process using a seven-point Likert-type scale. A correlation coefficient was calculated to assess the association between physicians' confidence in deprescribing and attitudes or barriers associated with deprescribing.
Many physicians (72%) reported general confidence in their ability to deprescribe. Most respondents (78%) reported they were comfortable deprescribing preventive medications, yet only half (53%) were comfortable deprescribing guideline-recommended therapies. Lack of evidence on discontinuing preventive medicines and concern about withdrawal side effects were reported to impede deprescribing by more than one-third of physicians. When medications were initially prescribed by another physician, 40% of physicians reported hesitance in deprescribing them. About half of physicians (45%) did not feel comfortable deprescribing when patients/caregivers believed that continuation of the medication was needed. Lack of time and difficulty engaging patients/caregivers in the deprescribing process were cited as barriers by about one in four physicians. There was no strong correlation between physicians' confidence and attitudes or barriers associated with deprescribing.
The study results show that physicians believe they are generally comfortable with deprescribing, although there are still several factors that hamper their ability to engage in the process. An improved understanding of physicians' views on deprescribing may help guide further research, and policies to help patients remain healthy while streamlining their medication regimen.
撤药是指停用或减少不再适用或不符合治疗目标的药物剂量的过程，这对于患有多种合并症和多重用药的老年患者至关重要。本研究的目的是评估初级保健医生对老年患者撤药的看法以及医生在意大利艾米利亚 - 罗马涅大区帕尔马地方卫生当局（LHA）撤药过程中遇到的潜在障碍。
160名医生（占帕尔马初级保健医生总数的57%）参加了一次与撤药相关的教育会议，并被要求匿名完成一份纸质调查问卷。参与者被要求使用七点李克特量表对关于他们对撤药的看法以及影响撤药过程的潜在因素的九个问题的同意程度进行评估。计算相关系数以评估医生对撤药的信心与撤药相关态度或障碍之间的关联。
许多医生（72%）表示对自己的撤药能力总体有信心。大多数受访者（78%）表示他们对停用预防性药物感到放心，但只有一半（53%）对停用指南推荐的治疗方法感到放心。超过三分之一的医生报告称，缺乏停用预防性药物的证据以及对撤药副作用 的担忧阻碍了撤药。当药物最初由另一位医生开处方时，40%的医生报告在撤药时犹豫不决。当患者/护理人员认为需要继续用药时，约一半的医生（45%）对撤药感到不自在。约四分之一的医生将缺乏时间以及在撤药过程中难以让患者/护理人员参与列为障碍。医生的信心与撤药相关态度或障碍之间没有很强的相关性。
研究结果表明，医生认为他们总体上对撤药感到放心，尽管仍有几个因素阻碍他们参与这一过程。更好地理解医生对撤药的看法可能有助于指导进一步的研究以及制定政策，以帮助患者在简化用药方案的同时保持健康。
