Patients beliefs and attitudes towards deprescribing: Can deprescribing success be predicted?

BackgroundThe ability of questionnaires such as the Patients’ Attitudes Towards Deprescribing (PATD) or the Beliefs about Medicines Questionnaire (Specific section) (BMQ-Specific) to successfully identify patients who will deprescribe remains unknown.ObjectiveTo determine if screening questionnaires assessing patients’ attitudes and beliefs towards medications and deprescribing can predict deprescribing outcomes.MethodsThis is a post-hoc secondary analysis of the D-PRESCRIBE trial. 489 community-dwelling adults (≥65 years) who were chronic users (≥3 months) of a potentially inappropriate medication were randomized to a pharmacist-led educational intervention or usual care. Association between baseline responses to PATD and BMQ-Specific items and successful deprescribing was calculated. To determine predictive ability of questionnaire items, receiver operating characteristic curves (ROC) were constructed and area under the curve was calculated.ResultsAt baseline, 86% of participants (95% confidence interval [CI] 83–89%) indicated a willingness to deprescribe, yet only 41% (95%CI 37–46%) successfully deprescribed. Six items were associated with deprescribing success, however, no PATD or BMQ-Specific item – either independently or in combination – meaningfully distinguished which participants succeeded or failed deprescribing attempts at 6-months (AUC < 0.7).ConclusionCurrent tools to assess patient's attitudes and beliefs towards medication use and/or deprescribing have low predictive validity for successful deprescribing.     

Development and validation of the patients’ attitudes towards deprescribing (PATD) questionnaire

Background There is a large amount of research into and promotion of rational prescribing, but there is a comparative lack of investigation into deprescribing. The success of deprescribing is likely to be dependent on both medical and patient factors. Objective The aim of this study was to develop and validate a tool to capture the views and beliefs of patients regarding cessation of medications. Setting Participants were recruited from a multidisciplinary clinic at the Royal Adelaide Hospital and Hampstead Rehabilitation Centre. Methods The patients’ attitudes towards deprescribing (PATD) questionnaire was developed through expert opinion and piloting. Psychometric testing included face, content and criterion validity, sensitivity and test–retest reliability. Results A final 15 item questionnaire was produced. Through piloting, expert review and gamma rank correlation with the previously validated beliefs about medicines questionnaire, the PATD was determined to be valid. Test-retesting resulted in a total concordance of 71.3 % (95 % confidence interval, 64.1–78.5 %). Conclusion The PATD has acceptable psychometric properties and has potential for future use in research and practice to not only determine patients’ willingness towards deprescribing, but also uncover what beliefs may influence this.     

Benefits of deprescribing on patients’ adherence to medications

Deprescribing is a holistic process of medication cessation that encompasses gaining a comprehensive medication list, identifying potentially inappropriate medications, deciding if the identified medication can be ceased, planning the withdrawal regimen and monitoring, support and follow-up. It is currently being investigated as a mechanism to reduce unnecessary or redundant medications. However, given the systematic and patient-centred nature of the deprescribing process, it is possible that it may also confer additional benefits such as improving adherence to medications, even if there is no net reduction in overall medication use. Specifically, deprescribing may improve adherence via reducing polypharmacy, reducing the financial costs associated with medication taking, increasing the patient’s medication knowledge through education, increasing patient engagement in medication management and resolution of adverse drug reactions. More research into deprescribing must be conducted to establish if these potential benefits can be realised, in addition to establishing any negative consequences.     

Stakeholder perspectives on pharmacist involvement in a memory clinic to review patients’ medication management and assist with deprescribing

BackgroundMemory clinics usually involve a team of health professionals who assess and review people with memory impairment. Memory clinic patients are typically older, have multiple comorbidities and potentially inappropriate polypharmacy. Pharmacists are not typically part of memory clinic teams.ObjectiveTo explore stakeholder perspectives on pharmacist involvement in a memory clinic to conduct medication reviews and assist with deprescribing potentially inappropriate/unnecessary medications.MethodsQuantitative and qualitative evaluation of stakeholder perspectives within a deprescribing feasibility study. Patient/carer questionnaires were administered at 6-month follow-up. Fax-back surveys were sent to general practitioners (GPs) shortly after the pharmacist review. A focus group was conducted with memory clinic staff and semi-structured interviews with pharmacists at conclusion of the study. Focus group/interviews were transcribed and thematically analysed.ResultsMost patients/carers found the pharmacist medication review helpful (84%, 31/37) and believed it was important to have pharmacists in the memory clinic (92%, 36/39). Twenty-one (48%) GPs responded to the survey; most found the pharmacist reports useful for identifying inappropriate medication and providing deprescribing recommendations (86% and 81%, respectively), and 90% thought a pharmacist review should be part of the memory clinic service. Feedback from memory clinic staff and pharmacists was largely positive. Questions were raised by some staff about whether deprescribing fell within the clinic's scope of practice. Challenges associated with memory clinic-GP communication were highlighted.ConclusionPatients, GPs and memory clinic staff were receptive to increased pharmacist involvement in the memory clinic. Stakeholder feedback will inform the development and delivery of pharmacist medication reviews and deprescribing in memory clinics.     

Hospital pharmacists’ perceived beliefs and responsibilities in indication-based off-label prescribing

International Journal of Clinical Pharmacy - Background Off-label prescribing is prevalent in healthcare. There is a lack of understanding of pharmacists’ attitudes toward the practice of...     

Physicians’ knowledge and attitudes toward scheduling

Objective: To determine physicians’ knowledge and attitudes of medico-legal issues regarding drug scheduling.

Methods: The cross sectional survey was designed to assess attitudes and mailed to 400 randomly selected physicians.

Results: A total of 155 (43.8%) of the 354 delivered surveys were returned. Physicians across all groups provided consistent responses suggesting a negative attitude about scheduling, a lack of understanding of scheduling issues and a harmful impact of scheduling on their practice. Physicians who saw 20 or more patients differed significantly from the other groups in 50% (4 of the 8) questions suggesting enhanced dissatisfaction.     

Frail elderly patients in primary care—their medication knowledge and beliefs about prescribed medicines

Purpose  The aim of this study was to describe elderly patients’ knowledge about and attitudes towards their medicines in Swedish primary care. Methods  Thirty-four patients aged 65 years and above with multiple illnesses were included. Medication knowledge was assessed with a questionnaire measuring knowledge about indication and possible adverse effects for each medicine. Attitudes were investigated with the Beliefs about Medicines Questionnaire. Results  The indication of at least 75% of their medicines was known to 71% of the patients. Patients with polypharmacy and multi-dose drug distribution respectively had significantly less knowledge. Eighty-four percent had no knowledge about possible adverse effects. For 93% of the patients, the benefits of the medication outweighed the costs (concerns). No correlation was found between attitudes and knowledge. Conclusions  The knowledge about indication was higher than previously seen, but the knowledge about possible adverse effects was poor. The patients had strong beliefs in the benefits of their medication.     

Physicians’ perceived barriers and enablers for deprescribing among older patients at public primary care clinics: a qualitative study

International Journal of Clinical Pharmacy - Background Increased harmful effects of medication resulting from polypharmacy, especially among older patients, is a significant concern globally....     

Cognitive-motivational predictors of excessive drinkers’ success in changing

Aims The purpose of this study was to identify cognitive (alcohol attentional bias, AAB) and motivational (motivational structure, MS; readiness to change, RTC) predictors of changes in excessive drinking. Materials and methods One hundred fifty-eight excessive drinkers not in treatment were administered a test battery and were re-tested 3 and 6 months later. The tests included the alcohol timeline followback, readiness to change questionnaire, alcohol Stroop (to measure AAB), personal concerns inventory (to measure MS), and a measure of family history of alcohol problems (FHAP). Results High RTC predicted short-term but not long-term reductions in drinking; both low AAB and high FHAP predicted long-term reductions. MS interacted with both AAB and RTC so that the greatest long-term drinking reductions occurred among participants with adaptive MS and low AAB and among those with adaptive MS and high RTC. Conclusion It was concluded that (a) both cognitive and motivational factors affect the likelihood of drinking reductions and (b) a complete understanding of drinking problems should be formulated in terms of both cognitive and motivational variables.     

Community pharmacists’ attitudes and opinions towards supplying clozapine

International Journal of Clinical Pharmacy - Background Clozapine is very effective for treatment-resistant schizophrenia, but its use has been limited due to the risk of agranulocytosis. From July...     

The moderating role of substance abusers’ personal attributes in predicting relapse and partner persuasiveness

In relationships where one partner is dependent on substances, the non-dependent, or “functional” partners use a variety of strategies to stop the abuse and prevent relapse. Inconclusive research results on the effectiveness of these strategies can be partially explained by the failure to consider personal characteristics of the substance abusers that may make them more or less receptive to their partners’ attempts at assisting them in their sobriety. This work explores the substance abusers’ anger, over-controlled hostility, and ego-strength as moderating factors influencing both the types and amounts of persuasive strategies used by the significant other. The sample was composed of 67 married or cohabitating couples with one functional and one substance-abusing partner (as assessed by the chemical use, abuse, and dependence (CUAD) scale). Participants’ personality variables were tested using the Minnesota Multiphasic Personality Inventory (MMPI), followed by videotaped interviews where they were independently asked about their own and their partner's behavior. Contrary to predictions, as the abusers’ anger and ego-strength increased so did their partners’ use of punishment and the consistency of the substance-abusing behavior. Finally, as the abusers’ ego-strength increased and over-controlled hostility decreased the partner presented more reinforcement of the substance abuse. These findings encourage a systems approach to the treatment of substance abuse, and provide insight into appropriate and effective strategies used by the functional partner in this system.