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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 ▲]

Detailed reference viewed: 55 (3 UL)