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Abstract：
BACKGROUND: Collaboration between physicians and pharmacists facilitates the conduct of medication optimisation efforts. In the context of deprescribing, pharmacists\' roles are often described as making deprescribing recommendations to physicians. Little is known about factors associated with pharmacists\' willingness to make deprescribing recommendations and their interprofessional collaboration with physicians in Swiss primary care settings.
OBJECTIVE: To explore pharmacists\' perspectives on medication optimisation and deprescribing in older adults, and their preferences for interprofessional collaboration in Swiss primary care settings.
METHODS: In this cross-sectional study, a random sample of 1000 pharmacist members of the Swiss Pharmacists Association pharmaSuisse was invited to participate in a survey on medication optimisation, deprescribing, and interprofessional collaboration. The survey contained three case vignettes of multimorbid patients with polypharmacy aged ≥ 80 years old, with different levels of dependency in activities in daily living (ADL) and cardiovascular disease (CVD). For each case vignette, pharmacists were asked if and which medications they would deprescribe. We calculated proportions of pharmacists\' willingness to deprescribe by case vignette and performed a multilevel logistic regression to assess associations between CVD, ADL, and willingness to deprescribe.
RESULTS: One hundred thirty-eight (14%) pharmacists responded to the survey: 113 (82%) were female, their mean age was 44 years (SD = 11), and 66% (n = 77) reported having never received any specific training on how to conduct structured medication reviews. Eighty-three (72%) pharmacists reported to be confident in identifying deprescribing opportunities. All pharmacists were willing to deprescribe ≥ 1 medication in all vignettes. Patients with CVD were at lower odds of having medications deprescribed (OR = 0.27, 95%CI 0.21 to 0.36). Willingness to deprescribe was lower with higher dependency in ADL (medium versus low dependency: OR = 0.68, 95%CI 0.54 to 0.87, high versus low dependency: OR = 0.72, 95%CI 0.56 to 0.91). However, the effect of dependency in ADL on willingness to deprescribe was significantly modified by the history of CVD. One hundred five pharmacists (97%) reported to interact with physicians to clarify questions regarding prescriptions at least once a week and 88 (81%) wished to be more involved in deprescribing and medication review.
CONCLUSIONS: Pharmacists were willing to make deprescribing suggestions for older patients with polypharmacy, but two-thirds reported having received no formal training on how to perform structured medication reviews. Pharmacists would like to be more involved in the process of medication review and deprescribing, which should be leveraged in the context of Swiss primary care settings.
OBJECTIVE: To explore pharmacists\' perspectives on medication optimisation and deprescribing in older adults, and their preferences for interprofessional collaboration in Swiss primary care settings.
METHODS: In this cross-sectional study, a random sample of 1000 pharmacist members of the Swiss Pharmacists Association pharmaSuisse was invited to participate in a survey on medication optimisation, deprescribing, and interprofessional collaboration. The survey contained three case vignettes of multimorbid patients with polypharmacy aged ≥ 80 years old, with different levels of dependency in activities in daily living (ADL) and cardiovascular disease (CVD). For each case vignette, pharmacists were asked if and which medications they would deprescribe. We calculated proportions of pharmacists\' willingness to deprescribe by case vignette and performed a multilevel logistic regression to assess associations between CVD, ADL, and willingness to deprescribe.
RESULTS: One hundred thirty-eight (14%) pharmacists responded to the survey: 113 (82%) were female, their mean age was 44 years (SD = 11), and 66% (n = 77) reported having never received any specific training on how to conduct structured medication reviews. Eighty-three (72%) pharmacists reported to be confident in identifying deprescribing opportunities. All pharmacists were willing to deprescribe ≥ 1 medication in all vignettes. Patients with CVD were at lower odds of having medications deprescribed (OR = 0.27, 95%CI 0.21 to 0.36). Willingness to deprescribe was lower with higher dependency in ADL (medium versus low dependency: OR = 0.68, 95%CI 0.54 to 0.87, high versus low dependency: OR = 0.72, 95%CI 0.56 to 0.91). However, the effect of dependency in ADL on willingness to deprescribe was significantly modified by the history of CVD. One hundred five pharmacists (97%) reported to interact with physicians to clarify questions regarding prescriptions at least once a week and 88 (81%) wished to be more involved in deprescribing and medication review.
CONCLUSIONS: Pharmacists were willing to make deprescribing suggestions for older patients with polypharmacy, but two-thirds reported having received no formal training on how to perform structured medication reviews. Pharmacists would like to be more involved in the process of medication review and deprescribing, which should be leveraged in the context of Swiss primary care settings.
摘要：
背景：医生和药剂师之间的合作促进了药物优化工作的开展。在取消处方的背景下，药剂师的角色通常被描述为向医生提出处方建议。关于药剂师愿意提出处方建议以及他们与瑞士初级保健机构医生的跨专业合作的相关因素知之甚少。
目的：探讨药剂师对老年人用药优化和取消处方的看法，以及他们在瑞士初级保健机构中进行跨专业合作的偏好。
方法：在这项横断面研究中，瑞士药剂师协会的1000名药剂师成员被邀请参加药物优化调查，开药,和跨专业合作。该调查包含3例年龄≥80岁的多药患者，在日常生活活动（ADL）和心血管疾病（CVD）中具有不同程度的依赖性。对于每个案例小插图，药剂师被问及他们是否会停用以及哪种药物。我们通过病例小插图计算药剂师放弃处方的意愿比例，并进行多水平逻辑回归以评估CVD之间的关联，ADL,和放弃处方的意愿。
结果：一百三十八（14％）药剂师回答了调查：113（82％）是女性，他们的平均年龄为44岁（SD=11），66%(n=77)报告从未接受过关于如何进行结构化药物审查的任何具体培训.83名（72％）的药剂师报告说，他们有信心识别开处方的机会。所有药剂师都愿意在所有小插曲中停用≥1种药物。患有CVD的患者服用处方药的几率较低（OR=0.27，95CI0.21至0.36）。ADL依赖性较高，开处方的意愿较低（中等依赖性与低依赖性：OR=0.68，95CI0.54至0.87，高依赖性与低依赖性：OR=0.72，95CI0.56至0.91）。然而,ADL依赖性对患者开处方意愿的影响被CVD病史显著改变.一百零五位药剂师（97％）报告说，每周至少一次与医生互动，以澄清有关处方的问题，而88位药剂师（81％）希望更多地参与开药和药物审查。
结论：药剂师愿意为老年多药患者提出处方建议，但三分之二的人报告说,他们没有接受过关于如何进行结构化药物审查的正式培训.药剂师希望更多地参与药物审查和开处方的过程，这应该在瑞士初级保健环境中加以利用。
目的：探讨药剂师对老年人用药优化和取消处方的看法，以及他们在瑞士初级保健机构中进行跨专业合作的偏好。
方法：在这项横断面研究中，瑞士药剂师协会的1000名药剂师成员被邀请参加药物优化调查，开药,和跨专业合作。该调查包含3例年龄≥80岁的多药患者，在日常生活活动（ADL）和心血管疾病（CVD）中具有不同程度的依赖性。对于每个案例小插图，药剂师被问及他们是否会停用以及哪种药物。我们通过病例小插图计算药剂师放弃处方的意愿比例，并进行多水平逻辑回归以评估CVD之间的关联，ADL,和放弃处方的意愿。
结果：一百三十八（14％）药剂师回答了调查：113（82％）是女性，他们的平均年龄为44岁（SD=11），66%(n=77)报告从未接受过关于如何进行结构化药物审查的任何具体培训.83名（72％）的药剂师报告说，他们有信心识别开处方的机会。所有药剂师都愿意在所有小插曲中停用≥1种药物。患有CVD的患者服用处方药的几率较低（OR=0.27，95CI0.21至0.36）。ADL依赖性较高，开处方的意愿较低（中等依赖性与低依赖性：OR=0.68，95CI0.54至0.87，高依赖性与低依赖性：OR=0.72，95CI0.56至0.91）。然而,ADL依赖性对患者开处方意愿的影响被CVD病史显著改变.一百零五位药剂师（97％）报告说，每周至少一次与医生互动，以澄清有关处方的问题，而88位药剂师（81％）希望更多地参与开药和药物审查。
结论：药剂师愿意为老年多药患者提出处方建议，但三分之二的人报告说,他们没有接受过关于如何进行结构化药物审查的正式培训.药剂师希望更多地参与药物审查和开处方的过程，这应该在瑞士初级保健环境中加以利用。
