Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States
Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States
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DOI：
10.1001/jamainternmed.2018.4720
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发表时间：
2018-12-01
影响因子：
39
通讯作者：
Boyd, Cynthia M.
中科院分区：
文献类型：
--
作者：
Reeve, Emily;Wolff, Jennifer L.;Boyd, Cynthia M.
重要性 老年人普遍使用有害和/或不必要的药物。这可能会导致本可避免的伤害，例如药物不良反应、跌倒、住院和死亡。初级保健医生报告说，患者对停止用药的抵制是取消处方的一个重大障碍。 目的 描述老年人对取消处方的态度，并确定个人特征是否与这些态度相关。 设计、设置和参与者 对于这项针对 65 岁及以上美国医疗保险受益人的基于人群的调查研究，数据来自于第 6 轮面对面访谈的用药态度模块。国家健康与老龄化趋势研究（第 6 轮加权回复率为 88.5%）。本模块中的问题取自患者对停用处方的态度调查问卷及其修订版。药物态度模块随机分配给三分之一（n = 2124）的国家健康和老龄化趋势研究参与者（该模块的加权响应率为 94.8%）。 主要结果和措施 对 2 个陈述的响应（“如果我的医生说这是可能的，我愿意停止一种或多种常规药物”和“我想减少我正在服用的药物数量”）是主要结果结果 在研究中纳入的 1981 年医疗保险受益人中，有 1149 名（55.2%，加权）是女性，大多数（n = 715 [54.6%，加权]）年龄在 65 至 74 岁之间。共有 1752 名（92.0%，加权）老年人表示，如果医生认为可以，愿意停止服用 1 种或多种药物，1241 名（66.6%，加权）老年人希望减少服用的药物数量。服用 6 种或更多药物的老年人比服用少于 6 种药物的老年人更有可能停止服用 1 种或多种药物（调整后比值比，2.90；95% CI，1.74-4.82）并希望减少正在服用的药物数量（调整后比值比，2.31；95% CI，1.71-3.13）。结论和相关性 考虑取消处方作为以患者为中心的综合护理的一部分的医生应该放心，如果医生认为可能的话，大多数美国老年人愿意取消一种或多种药物，并且超过三分之二的人希望减少他们正在服用的药物数量。
IMPORTANCE Use of harmful and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance to discontinuing medication use is a significant barrier to deprescribing.OBJECTIVE To describe the attitudes of older adults toward deprescribing and to determine whether individual characteristics are associated with these attitudes.DESIGN, SETTING, AND PARTICIPANTS For this population-based survey study of US Medicare beneficiaries 65 years and older, data were obtained from the Medication Attitudes module fielded through in-person interviews in round 6 of the National Health and Aging Trends Study (weighted response rate of round 6 was 88.5%). The questions in this module were drawn from the Patients' Attitudes Towards Deprescribing questionnaire and its revised version. The Medication Attitudes module was fielded to a random one-third (n = 2124) of the National Health and Aging Trends Study participants (weighted response rate of this module was 94.8%).MAIN OUTCOMES AND MEASURES Responses to 2 statements ("If my doctor said it was possible, I would be willing to stop one or more of my regular medicines" and "I would like to reduce the number of medicines I amtaking") were the main outcomes of interest.RESULTS Of the 1981 Medicare beneficiaries included in the study, 1149 (55.2%, weighted) were women, and the majority (n = 715 [54.6%, weighted]) were 65 to 74 years old. A total of 1752 (92.0%, weighted) older adults reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 1241 (66.6%, weighted) older adults wanted to reduce the number of medicines that they were taking. Older adults taking 6 or more medications had greater odds than those taking fewer than 6 medications of being willing to stop taking 1 or more of their medicines (adjusted odds ratio, 2.90; 95% CI, 1.74-4.82) and wanting to reduce the number of medicines that they were taking (adjusted odds ratio, 2.31; 95% CI, 1.71-3.13).CONCLUSIONS AND RELEVANCE Physicians considering deprescribing as part of comprehensive, patient-centered care should be reassured that a majority of older Americans are open to having 1 or more of their medicines deprescribed if their physician says it is possible, and more than two-thirds want to reduce the number of medicines that they are taking.