Publication

Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study

Schuling, J., Gebben, H., Veehof, L. J. G. & Haaijer-Ruskamp, F. M., 14-Jun-2012, In : BMC Family Practice. 13, 7 p., 56.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Schuling, J., Gebben, H., Veehof, L. J. G., & Haaijer-Ruskamp, F. M. (2012). Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Family Practice, 13, [56]. https://doi.org/10.1186/1471-2296-13-56

Author

Schuling, Jan ; Gebben, Henkjan ; Veehof, Leonardus Johannes Gerardus ; Haaijer-Ruskamp, Flora Marcia. / Deprescribing medication in very elderly patients with multimorbidity : the view of Dutch GPs. A qualitative study. In: BMC Family Practice. 2012 ; Vol. 13.

Harvard

Schuling, J, Gebben, H, Veehof, LJG & Haaijer-Ruskamp, FM 2012, 'Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study', BMC Family Practice, vol. 13, 56. https://doi.org/10.1186/1471-2296-13-56

Standard

Deprescribing medication in very elderly patients with multimorbidity : the view of Dutch GPs. A qualitative study. / Schuling, Jan; Gebben, Henkjan; Veehof, Leonardus Johannes Gerardus; Haaijer-Ruskamp, Flora Marcia.

In: BMC Family Practice, Vol. 13, 56, 14.06.2012.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Schuling J, Gebben H, Veehof LJG, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Family Practice. 2012 Jun 14;13. 56. https://doi.org/10.1186/1471-2296-13-56


BibTeX

@article{34c2dafde294498ba066c9a337907671,
title = "Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study",
abstract = "Background: Elderly patients with multimorbidity who are treated according to guidelines use a large number of drugs. This number of drugs increases the risk of adverse drug events (ADEs). Stopping medication may relieve these effects, and thereby improve the patient's wellbeing. To facilitate management of polypharmacy expert-driven instruments have been developed, sofar with little effect on the patient's quality of life. Recently, much attention has been paid to shared decision-making in general practice, mainly focusing on patient preferences. This study explores how experienced GPs feel about deprescribing medication in older patients with multimorbidity and to what extent they involve patients in these decisions.Methods: Focusgroups of GPs were used to develop a conceptual framework for understanding and categorizing the GP's view on the subject. Audiotapes were transcribed verbatim and studied by the first and second author. They selected independently relevant textfragments. In a next step they labeled these fragments and sorted them. From these labelled and sorted fragments central themes were extracted.Results: GPs discern symptomatic medication and preventive medication; deprescribing the latter category is seen as more difficult by the GPs due to lack of benefit/risk information for these patients. Factors influencing GPs'deprescribing were beliefs concerning patients (patients have no problem with polypharmacy; patients may interpret a proposal to stop preventive medication as a sign of having been given up on; and confronting the patient with a discussion of life expectancy vs quality of life is 'not done'), guidelines for treatment (GPs feel compelled to prescribe by the present guidelines) and organization of healthcare (collaboration with prescribing medical specialists and dispensing pharmacists.Conclusions: The GPs' beliefs concerning elderly patients are a barrier to explore patient preferences when reviewing preventive medication. GPs would welcome decision support when dealing with several guidelines for one patient. Explicit rules for collaborating with medical specialists in this field are required. Training in shared decision making could help GPs to elicit patient preferences.",
keywords = "General practice, Frail elderly, Polypharmacy, Withdrawing treatment, Preventive therapy, Quality of life, HEALTH OUTCOME PRIORITIZATION, TYPE-2 DIABETES-MELLITUS, SHARED DECISION-MAKING, OLDER PERSONS, MULTIPLE CONDITIONS, PRIMARY-CARE, PERCEPTIONS, CLINICIAN, LIFE, INFORMATION",
author = "Jan Schuling and Henkjan Gebben and Veehof, {Leonardus Johannes Gerardus} and Haaijer-Ruskamp, {Flora Marcia}",
year = "2012",
month = "6",
day = "14",
doi = "10.1186/1471-2296-13-56",
language = "English",
volume = "13",
journal = "BMC Family Practice",
issn = "1471-2296",
publisher = "BioMed Central Ltd.",

}

RIS

TY - JOUR

T1 - Deprescribing medication in very elderly patients with multimorbidity

T2 - the view of Dutch GPs. A qualitative study

AU - Schuling, Jan

AU - Gebben, Henkjan

AU - Veehof, Leonardus Johannes Gerardus

AU - Haaijer-Ruskamp, Flora Marcia

PY - 2012/6/14

Y1 - 2012/6/14

N2 - Background: Elderly patients with multimorbidity who are treated according to guidelines use a large number of drugs. This number of drugs increases the risk of adverse drug events (ADEs). Stopping medication may relieve these effects, and thereby improve the patient's wellbeing. To facilitate management of polypharmacy expert-driven instruments have been developed, sofar with little effect on the patient's quality of life. Recently, much attention has been paid to shared decision-making in general practice, mainly focusing on patient preferences. This study explores how experienced GPs feel about deprescribing medication in older patients with multimorbidity and to what extent they involve patients in these decisions.Methods: Focusgroups of GPs were used to develop a conceptual framework for understanding and categorizing the GP's view on the subject. Audiotapes were transcribed verbatim and studied by the first and second author. They selected independently relevant textfragments. In a next step they labeled these fragments and sorted them. From these labelled and sorted fragments central themes were extracted.Results: GPs discern symptomatic medication and preventive medication; deprescribing the latter category is seen as more difficult by the GPs due to lack of benefit/risk information for these patients. Factors influencing GPs'deprescribing were beliefs concerning patients (patients have no problem with polypharmacy; patients may interpret a proposal to stop preventive medication as a sign of having been given up on; and confronting the patient with a discussion of life expectancy vs quality of life is 'not done'), guidelines for treatment (GPs feel compelled to prescribe by the present guidelines) and organization of healthcare (collaboration with prescribing medical specialists and dispensing pharmacists.Conclusions: The GPs' beliefs concerning elderly patients are a barrier to explore patient preferences when reviewing preventive medication. GPs would welcome decision support when dealing with several guidelines for one patient. Explicit rules for collaborating with medical specialists in this field are required. Training in shared decision making could help GPs to elicit patient preferences.

AB - Background: Elderly patients with multimorbidity who are treated according to guidelines use a large number of drugs. This number of drugs increases the risk of adverse drug events (ADEs). Stopping medication may relieve these effects, and thereby improve the patient's wellbeing. To facilitate management of polypharmacy expert-driven instruments have been developed, sofar with little effect on the patient's quality of life. Recently, much attention has been paid to shared decision-making in general practice, mainly focusing on patient preferences. This study explores how experienced GPs feel about deprescribing medication in older patients with multimorbidity and to what extent they involve patients in these decisions.Methods: Focusgroups of GPs were used to develop a conceptual framework for understanding and categorizing the GP's view on the subject. Audiotapes were transcribed verbatim and studied by the first and second author. They selected independently relevant textfragments. In a next step they labeled these fragments and sorted them. From these labelled and sorted fragments central themes were extracted.Results: GPs discern symptomatic medication and preventive medication; deprescribing the latter category is seen as more difficult by the GPs due to lack of benefit/risk information for these patients. Factors influencing GPs'deprescribing were beliefs concerning patients (patients have no problem with polypharmacy; patients may interpret a proposal to stop preventive medication as a sign of having been given up on; and confronting the patient with a discussion of life expectancy vs quality of life is 'not done'), guidelines for treatment (GPs feel compelled to prescribe by the present guidelines) and organization of healthcare (collaboration with prescribing medical specialists and dispensing pharmacists.Conclusions: The GPs' beliefs concerning elderly patients are a barrier to explore patient preferences when reviewing preventive medication. GPs would welcome decision support when dealing with several guidelines for one patient. Explicit rules for collaborating with medical specialists in this field are required. Training in shared decision making could help GPs to elicit patient preferences.

KW - General practice

KW - Frail elderly

KW - Polypharmacy

KW - Withdrawing treatment

KW - Preventive therapy

KW - Quality of life

KW - HEALTH OUTCOME PRIORITIZATION

KW - TYPE-2 DIABETES-MELLITUS

KW - SHARED DECISION-MAKING

KW - OLDER PERSONS

KW - MULTIPLE CONDITIONS

KW - PRIMARY-CARE

KW - PERCEPTIONS

KW - CLINICIAN

KW - LIFE

KW - INFORMATION

U2 - 10.1186/1471-2296-13-56

DO - 10.1186/1471-2296-13-56

M3 - Article

VL - 13

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

M1 - 56

ER -

ID: 5609116