An international case-vignette study to assess general practitioners’ willingness to deprescribe (LESS)

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?