探索临床实践中医生对多重用药和减药的认知与态度：一项横断面研究。
Exploring the Knowledge and Attitudes of Physicians on Polypharmacy and Deprescribing in Clinical Practice: a Cross-Sectional Study.
作者信息
Eerike Madhavi, Raj Gerard Marshall, Rajendran Priyadharsini, Nayak Veena, Mathai Paul, Karra Vijaya Kumar, Varatharajan Sakthivadivel, Priyadarshini Rekha, Ramaswamy Gomathi, Gunasekaran Venugopalan, Selvaraj Jayachandran, Selvarajan Sandhiya, Chandran Anu, Kattimani Shivanand, Potangadi Rijesh, Kunhipilakkandiy Surendran Padinchara, Veettil Narayanan Puthiya, Rao Raghavendr, Prabhu Mukhyaprana, Cherian Jerin Jose, Anand Tanu
机构信息
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India.
Department of Pharmacology, JIPMER, Puducherry, India.
出版信息
Maedica (Bucur). 2025 Jun;20(2):264-274. doi: 10.26574/maedica.2025.20.2.264.
UNLABELLED
Objective: Polypharmacy, defined as the use of five or more medications, is increasingly prevalent among geriatric patients due to the complexity of managing multiple chronic conditions. This study aimed to evaluate physicians' knowledge of deprescribing, their familiarity with deprescribing tools and the factors influencing the deprescribing process.
MATERIALS AND METHODS
This cross-sectional survey was conducted among 290 physicians from four prominent tertiary care centers in South India between October 2023 and March 2024. A self-administered semi-structured questionnaire was employed to evaluate physicians' knowledge of polypharmacy, attitudes toward fall-risk-increasing drugs (FRIDs) and practices related to deprescribing interventions. Data collection was managed using Microsoft Excel, while descriptive and bivariate analyses were performed using SPSS to analyze the findings.
RESULTS
The study revealed that a majority of physicians (148; 51.0%) were unfamiliar with the term "deprescribing" and reported no formal training in the practice. Analysis based on physicians' knowledge scores showed that participants with higher scores (≥28) demonstrated significantly greater awareness of the Tool to Improve Medications in the Elderly via Review (TIMER) and Fit fOR The Aged (FORTA) list compared to those with lower scores. Among these more knowledgeable physicians, 48.1% (n=13; p=0.054) were aware of TIMER but had not utilized it in practice, while 33.3% (n=9; p=0.016) reported familiarity with the FORTA list without its practical application.
CONCLUSION
Deprescribing plays a vital role in managing polypharmacy and minimizing its associated risks in the aging population. However, its adoption is constrained by significant barriers, including a lack of awareness, insufficient formal training and limited integration of evidence-based deprescribing tools into clinical practice.
未标注
目的：多重用药定义为使用五种或更多药物，由于管理多种慢性病的复杂性，在老年患者中越来越普遍。本研究旨在评估医生对减药的认识、对减药工具的熟悉程度以及影响减药过程的因素。
材料与方法
2023年10月至2024年3月期间，对印度南部四个著名三级医疗中心的290名医生进行了这项横断面调查。采用自行填写的半结构化问卷来评估医生对多重用药的认识、对增加跌倒风险药物（FRIDs）的态度以及与减药干预相关的实践。使用Microsoft Excel进行数据收集，同时使用SPSS进行描述性和双变量分析以分析结果。
结果
研究表明，大多数医生（148名；51.0%）不熟悉“减药”一词，且表示未接受过该实践的正规培训。根据医生的知识得分进行分析显示，得分较高（≥28分）的参与者与得分较低的参与者相比，对通过审查改善老年人用药工具（TIMER）和老年人适宜药物（FORTA）清单的认识明显更高。在这些知识更丰富的医生中，48.1%（n = 13；p = 0.054）知道TIMER但未在实践中使用，而33.3%（n = 9；p = 0.016）表示熟悉FORTA清单但未实际应用。
结论
减药在管理多重用药和将其在老年人群中的相关风险降至最低方面起着至关重要的作用。然而，其采用受到重大障碍的限制，包括缺乏认识、正规培训不足以及循证减药工具在临床实践中的整合有限。
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