Evaluation of deprescribing in primary care, from a medical perspective

Detalhes bibliográficos
Autor(a) principal: Oliveira, Mariana Brito
Data de Publicação: 2023
Outros Autores: B. Oliveira, Mariana, Campos, Catarina, Lascasas, Joana, Ribeiro da Silva, Vera
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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spelling 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
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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
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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
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