School of Pharmacy, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
Pharmacy Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
BMC Geriatr. 2019 Apr 15;19(1):108. doi: 10.1186/s12877-019-1127-x.
Deprescribing is a partnership between practitioners, patients and caregivers. External characteristics including age, comorbidities and polypharmacy are poor predictors of attitude towards deprescribing. This hospital-based study aimed to describe the desire of patients and caregivers to be involved in medicine decision-making, and identify attitudinal predictors of desire to try stopping a medicine.
Patients and caregivers recruited from seven Older People's Medicine wards across two UK hospitals completed the revised Patients'Attitudes Towards Deprescribing (rPATD) questionnaire. Patients prescribed polypharmacy and caregivers involved in medication decision-making of such patients were eligible. A target of 150 patients and caregivers provided a 95% confidence interval of ±11.0% or smaller around rPATD item agreement. Descriptive statistics characterised participants and rPATD responses. Responses to items regarding desire to be involved in medication decision-making and desire to try stopping a medicine were used to address the aims. Binary logistic regression provided the adjusted odds ratios (OR) for predictors of desire to try stopping a medicine.
Patient participants (N = 75) were a median (IQ) 87.0 (83.0, 90.0) years old and the median (IQ) number of pre-admission medication was 8.0 (6.0, 10.0). Caregiver participants (N = 76) were a median (IQ) 70.0 (57.0, 83.0) years old and the majority were a spouse (63.2%). For patients and caregivers respectively, the following were reported: 58.7 and 65.8% wanted to be involved in medication decision-making; 29.3 and 43.5% reported a desire to try stopping a medicine. Attitudinal predictors of low desire to try stopping a medicine for patients and caregivers are a perception that there are no unnecessary prescribed medicines [OR = 0.179 (patients) and 0.044 (caregivers)] and no desire for dose reduction [OR = 0.199 (patients) and 0.024 (caregivers)]. A perception of not being prescribed too many medicines also predicted low patient desire to try stopping a medicine [OR = 0.195].
A substantial proportion of patients and caregivers did not want to be involved medication decision-making, however this should not result in practitioners dismissing deprescribing opportunities. The three diagnostic indicators for establishing desire to try stopping a medicine are perceived necessity of the medicine, appropriateness of the number prescribed medications and a desire for dose reduction.
减药是从业者、患者和护理人员之间的合作。外部特征，如年龄、合并症和多种药物治疗，是预测对减药态度的不良指标。这项基于医院的研究旨在描述患者和护理人员参与药物决策的愿望，并确定尝试停止用药的态度预测因素。
从英国两家医院的 7 个老年人医学病房招募了患者和护理人员，他们完成了修订后的患者对减药态度问卷（rPATD）。有资格参与的患者开了多种药物治疗，且护理人员参与了这些患者的药物决策。招募 150 名患者和护理人员可确保 rPATD 项目协议的 95%置信区间为±11.0%或更小。描述性统计数据描述了参与者和 rPATD 的反应。关于参与药物决策和尝试停止用药的愿望的项目的反应用于解决目标。二元逻辑回归提供了尝试停止用药愿望的预测因素的调整优势比（OR）。
患者参与者（N=75）的中位（IQR）年龄为 87.0（83.0，90.0）岁，入院前的中位（IQR）用药数量为 8.0（6.0，10.0）。护理人员参与者（N=76）的中位（IQR）年龄为 70.0（57.0，83.0）岁，其中大多数是配偶（63.2%）。对于患者和护理人员，分别有 58.7%和 65.8%希望参与药物决策；29.3%和 43.5%报告有尝试停止用药的愿望。对患者和护理人员而言，低尝试停止用药愿望的态度预测因素包括认为没有不必要的处方药物[OR=0.179（患者）和 0.044（护理人员）]和不希望减少剂量[OR=0.199（患者）和 0.024（护理人员）]。认为没有开太多药物也预测了患者低尝试停止用药的愿望[OR=0.195]。
相当一部分患者和护理人员不希望参与药物决策，但这不应导致从业者忽视减药机会。确定尝试停止用药愿望的三个诊断指标是药物的必要性、处方药物数量的适宜性和减少剂量的愿望。
