Centre for Health Technology and Services Research at the Associate Laboratory - Health Research Network (CINTESIS@RISE). Department of Education and Psychology. Universidade de Aveiro. Aveiro; Institute of Biomedical Sciences Abel Salazar. Universidade do Porto. Porto. Portugal.
Coimbra Institute for Clinical and Biomedical Research (iCBR). Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal.
Acta Med Port. 2024 Oct 1;37(10):684-696. doi: 10.20344/amp.21677.
The importance of deprescribing in clinical practice is growing, particularly in aging populations with polypharmacy scenarios, making it a crucial matter in Portugal, one of Europe's most aged nations. The aim of this study was to investigate deprescribing awareness, training, attitudes, and practices among Portuguese physicians to inform future healthcare strategies.
A cross-sectional study using an anonymous online questionnaire was disseminated through the Portuguese Medical Association. It gathered sociodemographic and professional data, and insights into deprescribing awareness, attitudes, training, and practices. Descriptive statistics were summarized as frequencies, percentages, medians, and interquartile ranges. For inferential analysis, the Chi-square test and Fisher's exact test were used to evaluate categorical variables, and the Mann-Whitney U test was used for continuous variables. The significance level was set at p < 0.05.
A total of 425 valid questionnaires were included. The participants were mostly women (61.6%), with a median age of 45 (IQR 34 - 42). General practice/family medicine (34.1%) and internal medicine (16.2%) were the most common medical specialties. While 81.2% of the respondents were familiar with the term 'deprescribing', 55.4% reported no training. A vast majority (91.9%) reported practicing deprescribing, but a smaller fraction employed specific methodologies to deprescribe (39.8%) and criteria for identifying potentially inappropriate medications (38.7%). Training in deprescribing was significantly associated with higher deprescribing awareness (p < 0.001), the use of specific deprescribing methods (p < 0.001), the use of criteria to identify potentially inappropriate medications (p < 0.001) and having certification in geriatrics by the Portuguese Medical Association (p = 0.006). Family physicians showed higher familiarity with and training in deprescribing than hospital-based specialists (p < 0.001). Deprescribing methodologies were adopted more often by family physicians than by hospital-based specialists (p = 0.004).
This study highlights widespread deprescribing awareness among Portuguese physicians, while simultaneously uncovering considerable gaps in training and inconsistencies in its application. These findings highlight the pressing need for targeted educational initiatives that could contribute to medication optimization for older adults in the national healthcare system. Furthermore, these findings emphasize the importance of policy development and medical education in promoting safe deprescribing.
在临床实践中，减少药物使用的重要性日益增加，尤其是在人口老龄化和多种药物治疗的情况下，这在葡萄牙这个欧洲最老龄化的国家尤为重要。本研究旨在调查葡萄牙医生对减少药物使用的认识、培训、态度和实践情况，以为未来的医疗保健策略提供信息。
本研究采用横断面研究设计，通过葡萄牙医学协会在线分发匿名问卷，收集医生的社会人口学和专业数据，以及对减少药物使用的认识、态度、培训和实践情况的见解。采用描述性统计方法总结频率、百分比、中位数和四分位间距。对于推断性分析，采用卡方检验和 Fisher 精确检验评估分类变量，采用 Mann-Whitney U 检验评估连续变量。显著性水平设为 p<0.05。
共纳入 425 份有效问卷。参与者主要为女性（61.6%），中位年龄为 45 岁（IQR 34-42）。普通科/家庭医学（34.1%）和内科（16.2%）是最常见的医学专业。虽然 81.2%的受访者熟悉“减少药物使用”这一术语，但 55.4%的受访者表示没有接受过相关培训。绝大多数（91.9%）医生表示正在实践减少药物使用，但只有一小部分医生（39.8%）使用特定方法减少药物使用，（38.7%）使用标准识别潜在不适当的药物。减少药物使用的培训与更高的减少药物使用意识（p<0.001）、使用特定的减少药物使用方法（p<0.001）、使用标准识别潜在不适当的药物（p<0.001）和获得葡萄牙医学协会老年医学认证（p=0.006）显著相关。家庭医生比医院专科医生更熟悉和接受减少药物使用的培训（p<0.001）。家庭医生比医院专科医生更常采用减少药物使用的方法（p=0.004）。
本研究表明，葡萄牙医生普遍认识到减少药物使用的重要性，但培训方面仍存在相当大的差距，应用也不一致。这些发现突显了针对老年人群体的药物优化，开展有针对性的教育活动的迫切需求。此外，这些发现强调了政策制定和医学教育在促进安全减少药物使用方面的重要性。
