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Abstract：
General practitioners (GPs) should regularly review patients\' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients\' health. However, deprescribing can be challenging for physicians. This study investigates GPs\' deprescribing decisions in 31 countries.
In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs\' deprescribing decisions.
Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57).
The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs\' deprescribing decisions.
Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57).
The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
摘要：
全科医生(GP)应定期检查患者的药物治疗，如有必要,开处方，因为不适当的多重用药可能会损害患者的健康。然而,开处方对医生来说可能是个挑战。这项研究调查了31个国家的全科医生取消处方的决定。
在这种情况下，小插图研究，全科医生被邀请参加一项在线调查，该调查包含三例年龄最大的多态患者的临床病例，这些患者可能患有不适当的多重用药。患者在日常生活活动（ADL）的依赖性方面有所不同，并且有或没有心血管疾病（CVD）病史。对于每种情况，我们问全科医生他们是否会在通常的做法中取消处方。我们计算了报告他们将开处方的全科医生的比例，并进行了多水平逻辑回归，以检查CVD病史与对全科医生开处方决定的依赖程度之间的关联。
在3175名受邀全科医生中，54％的人回答（N=1,706）。平均年龄为50岁，60%的受访者为女性。尽管GP特征存在差异，例如年龄(年龄较大的全科医生更有可能做出取消处方的决定)，在各个国家，总体而言,超过80%的全科医生报告,无论是否有CVD病史,他们都会在年龄最大的老年患者(>80岁)中停用至少一种药物的剂量.在ADL依赖性较高（OR=1.5，95CI1.25至1.80）和无CVD（OR=3.04，95CI2.58至3.57）的患者中，开处方的几率更高。
这项研究中的大多数全科医生愿意在年龄最大的多药多药患者中停用一种或多种药物。ADL依赖性增加的患者的意愿较高，而CVD患者的意愿较低。
在这种情况下，小插图研究，全科医生被邀请参加一项在线调查，该调查包含三例年龄最大的多态患者的临床病例，这些患者可能患有不适当的多重用药。患者在日常生活活动（ADL）的依赖性方面有所不同，并且有或没有心血管疾病（CVD）病史。对于每种情况，我们问全科医生他们是否会在通常的做法中取消处方。我们计算了报告他们将开处方的全科医生的比例，并进行了多水平逻辑回归，以检查CVD病史与对全科医生开处方决定的依赖程度之间的关联。
在3175名受邀全科医生中，54％的人回答（N=1,706）。平均年龄为50岁，60%的受访者为女性。尽管GP特征存在差异，例如年龄(年龄较大的全科医生更有可能做出取消处方的决定)，在各个国家，总体而言,超过80%的全科医生报告,无论是否有CVD病史,他们都会在年龄最大的老年患者(>80岁)中停用至少一种药物的剂量.在ADL依赖性较高（OR=1.5，95CI1.25至1.80）和无CVD（OR=3.04，95CI2.58至3.57）的患者中，开处方的几率更高。
这项研究中的大多数全科医生愿意在年龄最大的多药多药患者中停用一种或多种药物。ADL依赖性增加的患者的意愿较高，而CVD患者的意愿较低。
