Evaluation of deprescribing in primary care, from a medical perspective
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.32385/rpmgf.v39i6.13760 |
Resumo: | 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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Evaluation of deprescribing in primary care, from a medical perspectiveAvaliação da desprescrição nos cuidados de saúde primários, sob a perspetiva dos médicosDeprescribingPolypharmacyMultimorbidityPrimary health careFamily physicianDesprescriçãoPolimedicaçãoMultimorbilidadeCuidados de saúde primáriosMédico de famíliaIntroduction: 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.Introdução: A desprescrição terapêutica consiste na identificação e proposta de descontinuação de fármacos cujos danos superam os benefícios, sendo esta complexa gestão geralmente atribuída ao médico de família (MF). Objetivos: Determinar a autoperceção dos MF quanto às suas práticas de desprescrição, bem como as barreiras e fatores facilitadores identificados pelos mesmos. Como objetivo secundário pretendeu-se a sensibilização dos MF para a desprescrição terapêutica. Método: Estudo observacional e descritivo, no qual foi aplicado um questionário a internos de 3º e 4º anos e MF num Agrupamento de Centros de Saúde da região norte de Portugal. Foi aprovado pela Comissão de Ética e a análise estatística realizada no Microsoft Excel®. Resultados: Obtiveram-se 63 respostas, sendo 68,3% mulheres e a idade média 42,8 anos. Dos inquiridos, 81% eram especialistas e 57,1% e 14,3% tinham formação em cuidados paliativos e geriatria, respetivamente. Sobre a desprescrição, 98% observavam frequentemente doentes com multimorbilidade e 97% com polimedicação. No entanto, 49,2% da amostra referiu aplicar a desprescrição apenas ocasionalmente. Os fármacos mais frequentemente desprescritos foram anti-inflamatórios não esteroides, estatinas e bifosfonatos. As características do utente consideradas muito importantes para a desprescrição foram: qualidade (79,4%) e esperança de vida (71,4%), deterioração cognitiva (60%) e dependência física (49,2%). Os riscos (65,1%) e benefícios do fármaco (52,4%) e a existência de guidelines (46%) foram considerados os fatores (alheios ao doente) mais importantes para a prática da desprescrição. A barreira mais frequentemente observada foi o tempo limitado para revisão terapêutica (41,3%), enquanto a má adesão terapêutica foi o fator facilitador reconhecido ocasionalmente pela maioria (69,8%). Conclusão: Doentes com critérios de desprescrição são frequentemente reconhecidos pelos MF, escasseando ainda alguma proatividade nesta prática. A existência de guidelines foi considerada um fator muito importante e o tempo limitado uma barreira frequente. Assim, criar linhas orientadoras e consultas específicas poderão ser estratégias de melhoria.Associação Portuguesa de Medicina Geral e Familiar2023-12-22info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.32385/rpmgf.v39i6.13760https://doi.org/10.32385/rpmgf.v39i6.13760Portuguese Journal of Family Medicine and General Practice; Vol. 39 No. 6 (2023): Revista Portuguesa de Medicina Geral e Familiar; 563-81Revista Portuguesa de Medicina Geral e Familiar; Vol. 39 Núm. 6 (2023): Revista Portuguesa de Medicina Geral e Familiar; 563-81Revista Portuguesa de Medicina Geral e Familiar; Vol. 39 N.º 6 (2023): Revista Portuguesa de Medicina Geral e Familiar; 563-812182-51812182-517310.32385/rpmgf.v39i6reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://rpmgf.pt/ojs/index.php/rpmgf/article/view/13760https://rpmgf.pt/ojs/index.php/rpmgf/article/view/13760/11909Direitos de Autor (c) 2023 Revista Portuguesa de Medicina Geral e Familiarhttp://creativecommons.org/licenses/by-nc-nd/4.0info:eu-repo/semantics/openAccessOliveira, Mariana BritoB. Oliveira, MarianaCampos, CatarinaLascasas, JoanaRibeiro da Silva, Vera2024-09-17T12:00:44Zoai:ojs.rpmgf.pt:article/13760Portal AgregadorONGhttps://www.rcaap.pt/oai/openairemluisa.alvim@gmail.comopendoar:71602024-09-17T12:00:44Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Evaluation of deprescribing in primary care, from a medical perspective Avaliação da desprescrição nos cuidados de saúde primários, sob a perspetiva dos médicos |
title |
Evaluation of deprescribing in primary care, from a medical perspective |
spellingShingle |
Evaluation of deprescribing in primary care, from a medical perspective Oliveira, Mariana Brito Deprescribing Polypharmacy Multimorbidity Primary health care Family physician Desprescrição Polimedicação Multimorbilidade Cuidados de saúde primários Médico de família |
title_short |
Evaluation of deprescribing in primary care, from a medical perspective |
title_full |
Evaluation of deprescribing in primary care, from a medical perspective |
title_fullStr |
Evaluation of deprescribing in primary care, from a medical perspective |
title_full_unstemmed |
Evaluation of deprescribing in primary care, from a medical perspective |
title_sort |
Evaluation of deprescribing in primary care, from a medical perspective |
author |
Oliveira, Mariana Brito |
author_facet |
Oliveira, Mariana Brito B. Oliveira, Mariana Campos, Catarina Lascasas, Joana Ribeiro da Silva, Vera |
author_role |
author |
author2 |
B. Oliveira, Mariana Campos, Catarina Lascasas, Joana Ribeiro da Silva, Vera |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Oliveira, Mariana Brito B. Oliveira, Mariana Campos, Catarina Lascasas, Joana Ribeiro da Silva, Vera |
dc.subject.por.fl_str_mv |
Deprescribing Polypharmacy Multimorbidity Primary health care Family physician Desprescrição Polimedicação Multimorbilidade Cuidados de saúde primários Médico de família |
topic |
Deprescribing Polypharmacy Multimorbidity Primary health care Family physician Desprescrição Polimedicação Multimorbilidade Cuidados de saúde primários Médico de família |
description |
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. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-12-22 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.32385/rpmgf.v39i6.13760 https://doi.org/10.32385/rpmgf.v39i6.13760 |
url |
https://doi.org/10.32385/rpmgf.v39i6.13760 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://rpmgf.pt/ojs/index.php/rpmgf/article/view/13760 https://rpmgf.pt/ojs/index.php/rpmgf/article/view/13760/11909 |
dc.rights.driver.fl_str_mv |
Direitos de Autor (c) 2023 Revista Portuguesa de Medicina Geral e Familiar http://creativecommons.org/licenses/by-nc-nd/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Direitos de Autor (c) 2023 Revista Portuguesa de Medicina Geral e Familiar http://creativecommons.org/licenses/by-nc-nd/4.0 |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Associação Portuguesa de Medicina Geral e Familiar |
publisher.none.fl_str_mv |
Associação Portuguesa de Medicina Geral e Familiar |
dc.source.none.fl_str_mv |
Portuguese Journal of Family Medicine and General Practice; Vol. 39 No. 6 (2023): Revista Portuguesa de Medicina Geral e Familiar; 563-81 Revista Portuguesa de Medicina Geral e Familiar; Vol. 39 Núm. 6 (2023): Revista Portuguesa de Medicina Geral e Familiar; 563-81 Revista Portuguesa de Medicina Geral e Familiar; Vol. 39 N.º 6 (2023): Revista Portuguesa de Medicina Geral e Familiar; 563-81 2182-5181 2182-5173 10.32385/rpmgf.v39i6 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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mluisa.alvim@gmail.com |
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