Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands.
Faculty of Science and Engineering, Medical Pharmaceutical Sciences Programme, University of Groningen, Groningen, Netherlands.
Front Public Health. 2022 Feb 11;10:795043. doi: 10.3389/fpubh.2022.795043. eCollection 2022.
Deprescribing requires patients' involvement and taking patients' attitudes toward deprescribing into account. To understand the observed variation in these attitudes, the influence of contextual-level factors, such as country or healthcare setting, should be taken into account.
We conducted a systematic review of studies using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire among older adults. We searched articles in Medline and Embase up to 30 June 2021. PRISMA guideline was used for the search process and reporting. We summarized the outcomes from the rPATD and compared attitudes at study population level between high or low-middle-income countries, global regions, and healthcare settings using ANOVA testing. Correlations of the rPATD outcomes with the mean age of the study populations were tested. Associations with the rPATD outcomes at individual patient level extracted from the included studies were summarized.
Sixteen articles were included. Percentages of patients willing to stop medication were significantly lower in low-middle-income countries (<70% in Nepal and Malaysia) compared to high-income countries (>85% in USA, Australia, European countries). No significant differences were observed when results were compared by global region or by healthcare setting but a high willingness (>95%) was seen in the two studies conducted in an inpatient population. A higher mean age at study level was associated with a higher willingness to stop medication. At individual level, associations between patient characteristics, including demographics and education, and attitudes toward deprescribing showed inconsistent results.
Findings about attitudes toward deprescribing are influenced by contextual factors. Future research should pay more attention to the influence of the healthcare system and setting as well as the culture on patients' attitudes.
减药需要患者的参与，并考虑到患者对减药的态度。为了了解这些态度的观察到的差异，应该考虑到背景层面的因素，如国家或医疗保健环境。
我们使用修订后的患者对减药的态度问卷（rPATD）对老年人进行了系统评价。我们检索了截止到 2021 年 6 月 30 日在 Medline 和 Embase 中的文章。采用 PRISMA 指南进行检索过程和报告。我们总结了 rPATD 的结果，并通过 ANOVA 检验比较了高收入和中低收入国家、全球区域和医疗保健环境中研究人群的态度。测试了 rPATD 结果与研究人群平均年龄之间的相关性。总结了纳入研究中从个体患者水平提取的 rPATD 结果与个体患者特征（包括人口统计学和教育）之间的关联。
共纳入 16 篇文章。与高收入国家（美国、澳大利亚、欧洲国家>85%）相比，中低收入国家（尼泊尔和马来西亚<70%）的患者愿意停止用药的比例明显较低。按全球区域或医疗保健环境进行比较时，未观察到显著差异，但在两项在住院人群中进行的研究中，停药意愿较高（>95%）。研究水平的平均年龄较高与更高的停药意愿相关。在个体水平上，患者特征（包括人口统计学和教育）与对减药的态度之间的关联结果不一致。
关于减药态度的发现受到背景因素的影响。未来的研究应更多地关注医疗保健系统和环境以及文化对患者态度的影响。
