Evaluation of deprescribing in primary care, from a medical perspective
DOI:
https://doi.org/10.32385/rpmgf.v39i6.13760Keywords:
Deprescribing, Polypharmacy, Multimorbidity, Primary health care, Family physicianAbstract
Introduction: Therapeutic deprescribing consists of identifying and proposing the withdrawal medicines whose harms outweigh their benefits, and this complex management is usually part of the family physician (FP) role.
Objectives: Determine FPs’ self-perceptions of their deprescribing practices, as well as barriers and facilitators. A secondary aim was to raise FP awareness of deprescribing.
Methods: Observational and descriptive study in which FPs and 3rd and 4th-year family medicine residents in a northern region of Portugal completed an online survey. The study was approved by the ethics committee, and statistical analysis was performed in Microsoft Excel®.
Results: There were 63 responses, of which 68.3% were female, with a mean age of 42.8 years. In the sample, 81% were specialists and 57.1% and 14.3% had training in palliative care and geriatrics respectively. Regarding deprescribing, 98% frequently saw patients with multimorbidity and 97% with polypharmacy. However, 49.2% of respondents reported deprescribing only occasionally. The most commonly deprescribed drugs were non-steroidal anti-inflammatory drugs, statins, and bisphosphonates. Patient characteristics considered very important for deprescribing were: quality of life (79.4%), life expectancy (71.4%), cognitive orientation (60%), and physical dependence (49.2%). The risks (65.1%) and benefits (52.4%) of the drug and the existence of guidelines (46%) were considered the most important factors (not related to the patient) in the decision to deprescribe. The most frequently observed barrier was limited time for therapeutic review (41.3%), while poor adherence was occasionally recognized as a facilitator by the majority (69.8%).
Conclusion: Patients with deprescribing criteria are often recognized by the FP, but there is still a lack of proactivity in this practice. The existence of guidelines was considered a very important factor and limited time was a frequent barrier. Therefore, creating guidelines and specific consultations could be strategies for improvement.
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