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科威特老年诊所老年患者的减药态度及预测因素。

Deprescribing attitudes and predictors among older adults attending geriatric clinics in Kuwait.

作者信息

Alshammari Hesah, Al-Saeed Eman, Ahmed Zamzam, Aslanpour Zoe

机构信息

Al-Sabah Hospital, Shuwaikh Medical Area, Ministry of Health, Kuwait City, Kuwait.

Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.

出版信息

PLoS One. 2024 Dec 19;19(12):e0311853. doi: 10.1371/journal.pone.0311853. eCollection 2024.

Abstract

Deprescribing is defined as the reduction of medications to improve patient care. For effective deprescribing regular evaluation of medication adjustment regimens is required as it is documented to be an effective method to reduce polypharmacy and potentially inappropriate medications while improving patient well-being. Several factors, including patient-related aspects, influence the deprescribing process. Among these factors, patient willingness plays a pivotal role, making it essential to better understand their perspectives and attitudes towards medication use and deprescribing to successfully implement and maintain a deprescribing approach. We investigated the attitudes of older patients attending geriatric clinics in Kuwait toward deprescribing and identified predictors that influence their willingness to undergo this process. We enrolled patients aged ≥65 years who were attending geriatric clinics in primary care settings in Kuwait. These participants completed the revised Arabic version of the Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. The questionnaire was designed to assess the participants' willingness to participate actively in medication decision-making and their inclination toward discontinuing certain medicines. Descriptive statistics was applied to gain insight into the characteristics of the participants and their responses to the rPATD questionnaire. Binary logistic regression identified predictors influencing the desire to deprescribe among participants. The study included 535 participants, out of which 388 were analyzed, with 233 (43.6%) being women. The majority, 77% (n = 412), were aged between 65 and 74 years. Out of the total, 205 patients (38.4%) had one to two medical conditions and were prescribed between one and five medications. The participants showed a high willingness to deprescribe, and this willingness was inversely associated with sex (p = 0.15), age (p = 0.15), and polypharmacy (p = 0.044). Many older patients visiting geriatric clinics in primary care settings in Kuwait were receptive to the concept of deprescribing medications, particularly if advised by their doctor. Nevertheless, it was observed that male patients, individuals on more than 5 medications, and older age groups showed lower willingness to deprescribe.

摘要

减药定义为减少用药以改善患者护理。为了有效地减药,需要对药物调整方案进行定期评估,因为有记录表明这是减少多重用药和潜在不适当用药同时改善患者健康状况的有效方法。包括患者相关方面在内的几个因素会影响减药过程。在这些因素中,患者意愿起着关键作用,因此有必要更好地了解他们对用药和减药的看法及态度,以便成功实施和维持减药方法。我们调查了科威特老年诊所老年患者对减药的态度,并确定了影响他们接受这一过程意愿的预测因素。我们纳入了科威特初级保健机构老年诊所中年龄≥65岁的患者。这些参与者完成了修订后的阿拉伯语版患者对减药的态度(rPATD)问卷。该问卷旨在评估参与者积极参与用药决策的意愿以及他们停用某些药物的倾向。应用描述性统计来深入了解参与者的特征以及他们对rPATD问卷的回答。二元逻辑回归确定了影响参与者减药意愿的预测因素。该研究包括535名参与者,其中388名进行了分析,233名(43.6%)为女性。大多数人(77%,n = 412)年龄在65至74岁之间。总共有205名患者(38.4%)患有一至两种疾病,服用一至五种药物。参与者表现出较高的减药意愿,且这种意愿与性别(p = 0.15)、年龄(p = 0.15)和多重用药(p = 0.044)呈负相关。在科威特初级保健机构老年诊所就诊的许多老年患者接受减药概念,尤其是在医生建议的情况下。然而,观察到男性患者、服用超过5种药物的个体以及年龄较大的群体减药意愿较低。

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