University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, 789 South Limestone Avenue, Lexington, KY, 40536, USA.
University of Kentucky College of Arts and Sciences, Department of Sociology, 120 Patterson Drive, Lexington, KY, 40506, USA.
Res Social Adm Pharm. 2020 Oct;16(10):1502-1507. doi: 10.1016/j.sapharm.2020.02.014. Epub 2020 Mar 10.
Patients' attitudes toward deprescribing are crucial to understand before developing interventions, but no such data exists in the medically underserved, health disparities population of rural Appalachian United States.
OBJECTIVE(S): Assess Appalachian women's openness to deprescribing medications and determine if polypharmacy influenced their attitudes toward deprescribing.
Before and after a cognitive behavioral therapy intervention, middle-aged Appalachian women self-reported medication use and completed the revised Patients' Attitudes Toward Deprescribing Questionnaire (rPATD). Responses were described, stratified by presence of polypharmacy.
30 women completed the rPATD pre- and post-intervention (mean [SD] age 55.8 [6.6] years; 96.7% white). Those with polypharmacy (n = 16) had higher burden and involvement scores (median 2.8 vs 2.0, p = 0.01; 4.9 vs 4.6, p = 0.06), and lower appropriateness scores (3.4 vs 3.9, p = 0.04). Burden, concerns about stopping, and involvement factor scores were similar before and after the intervention (p = 0.08, 0.86, and 0.41 respectively). ≥90% of participants were satisfied with their current medications yet would be willing to stop one or more.
Middle-aged women in rural Appalachian United States are open to deprescribing; polypharmacy is associated with lower belief in the appropriateness of medications. Larger studies are needed to inform future deprescribing interventions for this and other similarly disadvantaged populations.
在开发干预措施之前，了解患者对减药的态度至关重要，但在美国农村阿巴拉契亚地区医疗资源不足、存在健康差异的人群中，没有这样的数据。
评估阿巴拉契亚女性对减药的开放性，并确定是否存在多种用药情况影响她们对减药的态度。
在认知行为疗法干预前后，中年阿巴拉契亚女性自我报告用药情况，并完成修订后的患者对减药态度问卷（rPATD）。根据是否存在多种用药情况对回答进行描述和分层。
30 名女性在干预前后完成了 rPATD（平均[标准差]年龄 55.8[6.6]岁；96.7%为白人）。存在多种用药情况的女性（n=16）有更高的负担和参与评分（中位数 2.8 比 2.0，p=0.01；4.9 比 4.6，p=0.06），以及更低的适宜性评分（3.4 比 3.9，p=0.04）。干预前后，负担、停止用药的担忧和参与因子评分相似（p=0.08、0.86 和 0.41）。≥90%的参与者对他们目前的药物感到满意，但愿意停止使用一种或多种药物。
美国农村阿巴拉契亚地区的中年女性对减药持开放态度；多种用药情况与对药物适宜性的信念降低有关。需要更大的研究来为这一人群和其他类似弱势群体的未来减药干预措施提供信息。
