Attitudes, Beliefs, and Experiences Regarding Polypharmacy

In This Article

Abstract and Introduction

Abstract

Objectives To capture people's attitudes, beliefs, and experiences regarding the number of medications they are taking and their feelings about stopping medications.

Design Administration of a validated questionnaire.

Setting Multidisciplinary ambulatory consulting service at the Royal Adelaide Hospital.

Participants Participants were individuals aged 18 and older (median 71.5) taking at least one regular prescription medication; 100 participants completed all items of the questionnaire, 65 of whom were aged 65 and older.

Measurements Participants were administered the 15-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire.

Results Participants were taking an average of 10 different prescription and nonprescription (including complementary), regular and as-needed medications. More than 60% felt that they were taking a "large number" of medications, and 92% stated that they would be willing to stop one or more of their current medications if possible. Number of regular medications, age, and number of medical conditions were not found to be correlated with willingness to stop a medication. The findings were similar in older and younger participants.

Conclusion This study has shown that a cohort of mostly older adults were largely accepting of a trial of cessation of medication(s) that their prescriber deemed to be no longer required. Because few factors were associated with willingness to cease medications, all patients should be individually evaluated for deprescribing.

Introduction

People speak the phrase "I take so many pills, I rattle when I walk" in pharmacies and medical offices daily. Although it may be said with humor, it may also reveal underlying concerns about the inconvenience, potential adverse effects, and cost of taking multiple medications.^[1–3] Polypharmacy can be appropriate in some patients (those with multiple comorbidities), and therefore it is appropriate to distinguish between appropriate polypharmacy and potentially inappropriate medications (PIMs). Research shows that 20% to 65% of elderly adults are taking at least one PIM,^[4–8] which puts them at increased risk of adverse drug reactions and mortality.^[9–12]

Although there is considerable information to guide prescribers in the safe and effective initiation of new medications, there is a proportionate lack of guidance regarding how inappropriate medications should be safely and effectively ceased.

The term "deprescribing" has been coined to describe a process of optimization of medication regimens through cessation of PIMs.^[13] It encompasses review of all medications; identification of PIMs that could be ceased, substituted, or reduced; planning of the deprescribing regimen in collaboration with the individual; and provision of review and support.^[13–15] Although there are many tools to identify PIMs,^[16,17] and a number of deprescribing algorithms have been proposed,^{[13–15,18,19]} none have been validated in a systematic fashion.

Consumer involvement in health care has long been identified as important,^[20] and a majority of individuals report wanting to be involved in the decision-making process.^[3] Despite the knowledge that people in general dislike taking medications,^[21] there is some evidence that they may be reluctant to stop one of their regular medications.^[22,23] No prior research has focused on quantifying how people feel about the number of medications they are taking or what their willingness to cease a medication would be, and therefore this consideration is missing from previously proposed deprescribing algorithms.

The Patients' Attitudes Towards Deprescribing (PATD) Questionnaire was developed and validated to explore people's attitudes, beliefs, and experiences regarding the number of medications that they are taking and how they would feel about cessation of one or more of their medications. Development included piloting and expert opinion reviews, after which the questionnaire underwent psychometric testing (face, content, and criterion validity; sensitivity; and test–retest reliability).^[24] In this first employment of the PATD, the aim was to investigate people's thoughts regarding the number of medications they were taking, or would be happy to take, and if and under what conditions they would be amenable to a trial of deprescribing of one or more of their regular medications. It also aimed to identify any factors that might influence these beliefs to determine whether there are any subgroups of individuals in whom deprescribing would be more or less accepted.

Table 1. Participant Characteristics
Characteristic	N	Value
Age, median (IQR)	100	71.5 (60–80)
Male, %	100	45
English as a second language,%	100	29
Born outside of Australia, %^a	100	47
Dosage administration aid user, %^b	100	37
Medications self-managed, %	100	82
Living alone, %	99	36
Number of medications, median (IQR)	100	10 (7–13)
Minimum number of tablets or capsules taken daily, median (IQR)	100	9.5 (6–12)
Number of medical conditions, median (IQR)	100	6 (4–8)
Beliefs About Medicines Questionnaire score, median (IQR)
Necessity^c	49	21 (19–25)
Concernd	49	14 (12–18)
Wake Forest Physician Trust Score, median (IQR)^e	47	43 (37–47)
Drug Burden Index, median (IQR)^f	89	0 (0–1)
Geriatric Depression Scale score, median (IQR)^g	77	4 (2–8)
Mini-Mental State Examination score, median (IQR)^h	40	28 (26–30)
Morisky Medication Adherence score, median (IQR)ⁱ	47	0 (0–2)
Current holder of medication discount card, %	100	79
Current holder of Private Health Insurance, %	100	34

IQR = interquartile range.
^aMost common countries were United Kingdom (13%), Italy (11%), and Greece (8%).
^b12% self-packed, 7% packed by family or friend, 18% pharmacist packed.
^cPossible range 5 to 25, higher score indicating greater belief in positive effects of medications on health and perceived necessity for maintaining health.
^dPossible range 5 to 25, higher score indicating greater concern about adverse consequences of medications.
^ePossible range 10 to 50, higher score indicating greater trust in physician.
^fMinimum score 0, higher score indicating more exposure to medications with sedative and anticholinergic effects.
^gScore of ≥6 indicates depression.
^hScore of ≤23 indicates cognitive impairment.
ⁱScore of 0 indicates high, 1 to 2 indicates medium, and >2 indicates low adherence to medications.

Table 2. Results from Questions One to Ten of the Patients' Attitudes Towards Deprescribing Questionnaire
Question	Strongly Agree %	Agree %	Unsure %	Disagree %	Strongly Disagree %
1. I feel that I am taking a large number of medications.	21	44	7	25	3
2. I am comfortable with the number of medications that I am taking.	16	53	8	22	1
3. I believe that all my medications are necessary.	29	49	17	4	1
4. If my doctor said it was possible, I would be willing to stop one or more of my regular medications.	38	54	5	3	0
5. I would like to reduce the number of medications that I am taking.	32	36	14	14	4
6. I feel that I may be taking one or more medications that I no longer need.	4	12	21	50	13
7. I would accept taking more medications for my health conditions.	12	59	4	23	2
8. I have a good understanding of the reasons I was prescribed each of my medications.	25	65	8	2	0
9. Having to pay for fewer medications would play a role in my willingness to stop one or more of my medications.	2	30	10	48	10
10. I believe one or more of my medications is giving me side effects.	5	26	15	45	9

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People's Attitudes, Beliefs, and Experiences Regarding Polypharmacy and Willingness to Deprescribe

Abstract and Introduction

Abstract

Introduction

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References

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Authors and Disclosures

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