Geriatric Care 2020; volume 6:8703 General practitioner attitudes medications, however almost half expressed and confidence to deprescribing doubts regarding deprescribing when Correspondence: Pier Riccardo Rossi, Scuola medication was initially prescribed by a Piemontese di Medicina Generale; Società for elderly patients colleague (45%) or when patient and/or Italiana di Medicina Generale e delle Cure caregiver supported the opportunity to Primarie; General Practitioner, Torino Local Health Authority, via Emilio Ghione 40, Pier Riccardo Rossi,1-3 Sarah E. Hegarty,4 continue the assumption (49%). Around a 5 6 10156 Torino, Italy. Vittorio Maio, Marco Lombardi, third of doctors maintain that the absence of E-mail: [email protected] Andrea Pizzini,1-3 Aldo Mozzone,1-3 strong evidence supporting deprescribing Marzio Uberti,1-3 Simonetta Miozzo1,2,7 prevents them from considering it (38%), Key words: Deprescribing; general practi- that they do not have the necessary time to tioner; attitude; primary care; elderly. 1Scuola Piemontese di Medicina 2 effectively go through the process of Generale, Torino, Italy; Società Italiana deprescribing (29%), and that fear of Acknowledgments: we thank for their contri- di Medicina Generale e delle Cure possible effects due on withdrawal prevents bution the following tutors of the Scuola Primarie, Torino, Italy; 3General Piemontese di Medicina Generale: Caposieno them from deprescribing (31%). There was M, Araldi M, Boella G, Fassone R, Piano P, Practitioner, Torino Local Health no strong correlation between physicians’ 4 Torta F, Morato P, Di Gravina G, Rumore A, Authority, Torino, Italy; Division of confidence and attitudes or barriers Vitali S, Mandas R, Bianchi S, Raiteri G. Biostatistics, Department of associated with deprescribing. Pharmacology and Experimental The present study confirms that general Contributions: the authors contributed equally. Therapeutics, Thomas Jefferson practitioners sense the importance of deprescribing and feel prepared to face it Conflict of interest: the authors declare no University, Philadelphia, PA, USA; potential conflict of interest. 5College of Population Health, Thomas managing communication with patients and Jefferson University, Philadelphia, PA, caregivers, but find barriers when enacting Received for publication: 2 December 2019. USA; 6Parma Local Health Authority, the practice in a real-life context. Revision received: 19 January 2020. Parma, Italy; 7General Practitioner, Accepted for publication: 24 Janauary 2020. Pinerolo-Collegno Local Health onlyThis work is licensed under a Creative Authority, Pinerolo-Collegno (TO), Italy How this fits in Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). Data about physicians’ confidenceuse and ©Copyright: the Author(s), 2020 attitudes toward deprescribing are limited. Licensee PAGEPress, Italy Abstract This study found that general practitioners Geriatric Care 2020; 6:8703 recognize the importance of deprescribing doi:10.4081/gc.2020.8703 Deprescribing is a patient-centered and feel comfortable to undertake the process of medication withdrawal intended deprescribing process with patients and to achieve improved health outcomes caregivers. However, several barriers when through discontinuation of one or more enacting the practice in a real-life context detrimental pharmacological interactions, medications that are either potentially were identified. Study results can be used to falls, decreased cognitive function,2,3 and the harmful or no longer required. plan educational and training activities for decrease in potential pharmacological The objective of this study was to assess primary care physicians and other health benefits. the perceptions of primary care physicians care professionals involved in the Guidelines motivating drug prescription on deprescribing and potential barriers to medication prescription process, as well as derive from case studies on single deprescribing in the Local Health Authority to design strategies for improving patients’ pathologies and in most cases on selected (LHA) of Turin, Piedmont, Italy. Secondary understanding of appropriate use of populations: this approach immediately objective was to evaluate educational needs medications. In addition, these results can excludes polymorbid and/or elderly of primary care physician. provide useful elements for political patients.4-6 It can therefore be said that Cross sectional survey of primaryNon-commercial care decision-makers and for those who are polypharmacy on elderly patients often physicians working in the LHA of Turin, delegated to organize healthcare services for represent isolated experiments.7 The Piedmont, Italy. the elderly. challenge is to establish, based on each 439 GPs (71.3% of the total number of individual patient, whether it is possible to primary care physicians) attended an introduce a new medication or to deprescribe educational session related to deprescribing one based on the current health situation and were asked to anonymously answer a Introduction while also respecting the patient’s and paper survey. Participants were asked to caregiver’s preferences. complete a previously published questionnaire Polypharmacy is an ever-growing Polypharmacy must, therefore, be about deprescribing and potential factors healthcare issue, mainly common in elderly monitored and constantly adapted to the affecting the deprescribing process. patients. While it can sometimes be patient’s needs over time. All healthcare A correlation coefficient was calculated necessary and motivated by multimorbidity,1 practitioners should consider the positive to assess the association between physicians’ polypharmacy can still represent an issue for and negative potential of polypharmacy, but confidence in deprescribing and attitudes or at least two main reasons: the risk of the best-suited figures to take care of the barriers associated with deprescribing. pharmacological interactions and adverse problem are General Practitioners (GPs) who Many GPs (71%) reported general reactions (ADR) on the one hand and a operate in the context of primary care and confidence in their ability to deprescribe. decrease in compliance (adherence to the are ultimately in charge of caring for the Most respondents (83%) reported they were therapy) on the other hand. Consequences person and have knowledge of their history comfortable deprescribing preventive can be excessive hospitalization because of and quality of life. [Geriatric Care 2020; 6:8703] [page 1] Article Deprescribing has recently been defined such as suspension of a drug for either deprescribing, however almost half as follows: a patient-centered process of preventive or therapeutic use, the ability to expressed doubts regarding deprescribing medication withdrawal intended to achieve motivate patients towards deprescribing, and when medication was initially prescribed by improved health outcomes through the barriers to deprescribing. Doctors were a colleague (45%) or when patient and/or discontinuation of one or more medications asked to indicate the degree to which they caregiver supported the opportunity to that are either potentially harmful or no agreed with the nine statements using a continued use of said drugs (49%). Around longer required.8 Such a process can very Likert-type scale ranging from 1 (highly a third of doctors maintain that the absence well be referred to the concept of Quaternary disagree) to 7 (strongly agree). of strong evidence supporting deprescribing Prevention (P4).9 P4 is defined as: Actions During the year 2018 a group of tutors prevents them from considering it (38%), taken to identify a patient or a population at instructed by the Scuola Piemontese di that they do not have the necessary time to risk of over-medicalization, to protect Medicina Generale (School of General effectively go through the process of him/her from invasive medical procedures, medicine in Piedmont) developed and deprescribing (29%), and the fear of possible and to offer them ethically and medically presented an educational program on effects brought on from the interruption of acceptable treatment procedures.10 P4 is a deprescribing sponsored by the Turin LHA. said drugs could possibly prevent them from critical look at medical activities with an The seminars, held over the course of two deprescribing (31%). (Table 3). emphasis on the need not to harm.11 and is evenings, were mandatory and took place Correlation analyses between the first consider by WONCA a task for GPs.9 Some within the context of monthly team meetings statement and other statements revealed a studies evaluated the effectiveness of from April 2018 to November 2018. The weak correlation between perceived level of deprescribing, finding improved quality of questionnaire was voluntary and anonymous expertise and the ability to deprescribe life and no association to significant risks or and was presented at the beginning of the medication initially prescribed by another withdrawal symptoms.12,13 Of the potential second evening (October-November 2018). colleague (fifth statement, rho=0.33) and the benefits, there are still many obstacles that All answers were collected on paper and ability to motivate the patient to begin the make deprescribing difficult for physicians. then keyed into an excel spreadsheet. process of deprescribing ( ninth statement, Some studies highlight how the lack of time, Descriptive statistics were calculated to rho= 0.33) (Table 4.) Overall, there was no difficulty communicating