University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands.
School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Institut Teknologi Bandung (ITB), Bandung, Indonesia.
BMC Geriatr. 2023 Jan 12;23(1):21. doi: 10.1186/s12877-022-03718-9.
Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people with type 2 diabetes (T2D). It seems that many patients in low-middle-income countries are not willing to have their medicines deprescribed. This study aims to assess attitudes of Indonesian patients with T2D towards deprescribing in general and regarding specific cardiometabolic medicines, and factors influencing their willingness to stop medicines.
Primary care patients with T2D of ≥60 years in Indonesia completed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Attitudes in general and for cardiometabolic medicines were reported descriptively. Proportions of patients willing to stop one or more medicines when recommended by different healthcare professionals were compared with Chi-square test. Multiple regression analysis was used to analyse the influence between patient-related factors and the willingness to stop medicines.
The survey was completed by 196 participants (median age 69 years, 73% female). The percentages willing to stop medicines were 69, 67, and 41%, when the general practitioner (GP), the specialist, or the pharmacist initiates the process (p-value < 0.001). Higher perceived burden of medicines (p-value = 0.03) and less concerns about stopping (p-value < 0.001) were associated with a higher willingness to stop medicines if proposed by the GP. Patients using multiple glucose-regulating medicines were less willing to stop (p-value = 0.02). Using complementary or alternative medicines was not associated with the willingness to stop. If proposed by their pharmacist, patients without substantial education were more willing to stop than educated patients.
Only two-thirds of older people with T2D in Indonesia were willing to stop one or more of their medicines if the GP or specialist recommended this, and even less when the pharmacist proposed this. Attention should be given to concerns about stopping specific medicines, especially among patients using multiple glucose-lowering medicines, who may be more eligible but were less willing to accept deprescribing.
在患有多种药物治疗的老年患者中，包括患有 2 型糖尿病（T2D）的患者，建议减少预防药物的使用。似乎许多中低收入国家的患者不愿意减少药物的使用。本研究旨在评估印度尼西亚 T2D 患者对减少药物治疗的总体态度以及对特定心血管代谢药物的态度，以及影响他们停止用药意愿的因素。
印度尼西亚年龄≥60 岁的初级保健 T2D 患者完成了修订后的患者对减少药物治疗的态度（rPATD）问卷。报告了对一般药物和心血管代谢药物的态度。使用卡方检验比较了不同医疗保健专业人员建议停止一种或多种药物时患者愿意停止药物治疗的比例。使用多元回归分析分析患者相关因素与停止用药意愿之间的关系。
该调查共完成了 196 名参与者（中位年龄 69 岁，73%为女性）。当全科医生（GP）、专科医生或药剂师启动该过程时，愿意停止用药的比例分别为 69%、67%和 41%（p 值<0.001）。如果 GP 建议减少药物治疗，患者感知到药物负担更高（p 值=0.03）且对停药的担忧更少（p 值<0.001），则更愿意停止用药。使用多种血糖调节药物的患者不太愿意停药（p 值=0.02）。使用补充或替代药物与停药意愿无关。如果是由药剂师建议，未受过高等教育的患者比受过高等教育的患者更愿意停药。
印度尼西亚只有三分之二的 T2D 老年患者如果 GP 或专科医生建议减少一种或多种药物治疗，他们愿意停止用药，而如果药剂师建议减少用药，他们则更不愿意接受。应关注停止使用特定药物的担忧，尤其是在使用多种降血糖药物的患者中，这些患者可能更符合资格，但却不太愿意接受减少药物治疗。
