Deprescribing: The three types of patients to consider

When it comes to deprescribing in the elderly, there are three different types of patients to consider

When it comes to deprescribing in the elderly, there are three different types of patients to consider, the first national meeting on the Choosing Wisely initiative in Melbourne has been told.

Patients fall into three roughly equal categories, and these categories can help guide the type of advice given by clinicians to elderly patients when discussing polypharmacy, according to Dr Jesse Jansen, a senior research fellow at the University of Sydney school of public health.

The first group can be classified as those patients who are “attached to their medicines”. These were patients who highly valued medication and generally had negative attitudes towards deprescribing, which ranged from disinterested to resistant, said Dr Jansen, who will be presenting her research into shared decision making and its impact on deprescribing at the meeting.

More positively, patients in this group generally place a high amount of trust in their doctor. They like to be informed but ultimately prefer to leave decisions to their clinician.

The second type, which make up the largest group, fall into the “would consider deprescribing” category. These patients have ambivalent attitudes towards medicines, valuing their benefit but disliking the side effects and hassle of taking them.

These people were likely to be willing to consider deprescribing and were generally informed and aware of deprescribing options, Dr Jansen said.

They also tend to be proactive patients and have a preference for shared decision making.

The final group are those who “defer to others”. These patients hold mildly positive attitudes towards medicines but generally do not really give medicines much thought.

They are commonly unaware that deprescribing is an option, and prefer to defer decisions to their doctor or companion.

The research on which these patient categories are based, involved 30 qualitative interviews with over-75-year-olds and their companions. The insights were used to develop a shared decision-making tool aimed at facilitating deprescribing discussions between patient, companion, GP and pharmacist.

Recognising these three types of patients would help health professionals engage patients in their own care which was often quite challenging for certain patient types, Dr Jansen said.

“For some it might be that you need to help them think a bit more about the medicines and educate them a bit more,” she said.

Whereas for others, who were already aware of what medicines they were taking, identifying preferences and goals would be appropriate, she said.

“A massive proportion of patients take 10 or more medications and the potential for harms associated with taking so many medications is incredible,” Dr Jansen said.

Polypharmacy is a substantial burden on a patient, and while it was not always inappropriate to be on multiple medications, it was very important to at least try to reduce this burden.