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See detailAn international case-vignette study to assess general practitioners’ willingness to deprescribe (LESS)
Tabea Jungo, Katharina; Mantelli, Sophie; Rozsnyai, Zsofia et al

in Collins, Claire (Ed.) Abstract Book of the 87th EGPRN Meeting (2018, November 14)

Background: Globally, many oldest-old (>80 years of age) suffer from several chronic conditions and take multiple medications. Ideally, their general practitioners (GPs) regularly and systematically ... [more ▼]

Background: Globally, many oldest-old (>80 years of age) suffer from several chronic conditions and take multiple medications. Ideally, their general practitioners (GPs) regularly and systematically search for inappropriate medications and, if necessary, deprescribe those. However, deprescribing is challenging due to numerous barriers not only within patients, but also within GPs. Research questions: How does the willingness to deprescribe in oldest-old with polypharmacy differ in GPs from different countries? What factors do GPs in different contexts perceive as important for deprescribing? Method: We assess GPs' willingness to deprescribe and the factors GPs perceive to influence their deprescribing decisions in a cross-sectional survey using case-vignettes of oldest-old patients with polypharmacy. We approach GPs in 28 European countries as well as in Israel, Brazil and New Zealand through national coordinators, who administer the survey in their GP network. The case vignettes differ in how dependent patients are and whether or not they have a history of cardiovascular disease (CVD). For each case vignette, GPs are asked if and which medication they would deprescribe. GPs further rate to what extent pre-defined factors influence their deprescribe decisions. We will compare the willingness to deprescribe and the factors influencing deprescribing across countries. Multilevel models will be used to analyze the proportions of the deprescribed medications per case along the continuum of dependency and history of CVD and to analyze the factors perceived as influencing deprescribing decisions. Results: As of early-July 2018, the survey has been distributed in 14 countries and >650 responses have been returned. We will present first results at the conference. Conclusions: First, assessing GPs’ willingness to deprescribe and comparing the factors influencing GPs’ deprescribing decisions across countries will allow an understanding of the expected variation in the willingness to deprescribe across different contexts. Second, it will enable the tailoring of specific interventions that might facilitate deprescribing in oldest-old patients. Points for discussion: How can we explain differences across countries? How can the results be translated into practice in order to help GPs to optimize deprescribing practices? What factors could help GPs to implement deprescribing in oldest-old patients with polypharmacy? [less ▲]

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See detailDefining feasibility of Primary care strategies to disclose, counsel and provide access to advocacy on family violence.
Pas; Gomez Bravo, Raquel UL; Clavería, Ana et al

in Collins, Claire (Ed.) Abstract Book of the 87th EGPRN Meeting (2018, November 14)

Background: Family violence (FV) is a widespread public health problem and serious consequences. One third of European women suffer from partner violence in their adult lifetime while on fourth of ... [more ▼]

Background: Family violence (FV) is a widespread public health problem and serious consequences. One third of European women suffer from partner violence in their adult lifetime while on fourth of situations of partner violence children are present. Elderly abuse is present between 10 to 20 % of the population above 60 General practice is often a point of contact for victims but they tend to hesitate or feel ashamed to ask for assistance. GPs generally lack training in disclosing and supporting FV, feel uncomfortable about asking and may be hindered by lack of facilities where to refer. In 2018, WONCA encourages all national colleges and academies to develop policy and implementation strategies on family violence identification and response for intimate partner violence, child abuse and elder abuse. This recommendation states it is needed to develop research and define performance and outcome measures for general practitioners/family doctors and primary care teams in each of our member nations; implementation strategies for comprehensive family violence care should be enabled and evaluated. Research questions: To define needs and concerns of practice teams and analyze possibilities for practice management across European Countries. Method: A Delphi approach modified according to RAND is proposed to develop a consensus using online collection of data. A steering group will be composed of delegates recruited form EGPRN and EUROPREV members to constitute a nominal group validating questions and authorising feedback to respondents for each Delphi round. Country representatives in the project will select a representative sample in each country to allow for generalisability of conclusions per country and European wise. Collaboration with national colleges is encouraged. A meeting at EGPRN in October 2018 will further detail the methodology. A constant comparative methodology using computer software (eg. NVIVO or similar) will be followed analysing data on each question highlighting similarities and differences between answers thus constructing an underlying model about concerns and possible solutions proposed. Points for discussion: How to constitute a sample per country to allow for generalisability. What are main focuses for consensus development? [less ▲]

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See detailBurden of cardiovascular disease across 29 countries and GPs’ decision to treat hypertension in oldest-old
Streit, Sven; Gussekloo, Jacobijn; Burman, Robert A. et al

in Scandinavian Journal of Primary Health Care (2018)

Objectives: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in ... [more ▼]

Objectives: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. Design: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. Setting: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. Subjects: This study included 2543 GPs from 29 countries. Main outcome measures: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (!50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. Results: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00–4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12–4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56–1.98). Conclusions: GPs’ choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD [less ▲]

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See detailVariation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries
Streit, Sven; Verschoor, Marjolein; Rodondi, Nicolas et al

in BMC Geriatrics (2017)

Background In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent ... [more ▼]

Background In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision. Methods Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP. Results The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs’ decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48–0.59; ORs per country 0.11–1.78). Conclusions Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making. [less ▲]

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