scholarly journals General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katharina Tabea Jungo ◽  
Sophie Mantelli ◽  
Zsofia Rozsnyai ◽  
Aristea Missiou ◽  
Biljana Gerasimovska Kitanovska ◽  
...  
Keyword(s):  
General Practitioners ◽  
Online Survey ◽  
Oldest Old ◽  
Case Vignette ◽  
Old Patients ◽  
Usual Practice ◽  
Vignette Study ◽  
History Of ◽  
The Mean ◽  
Multimorbid Patients

Abstract Background 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. Methods 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. Results 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). Interpretation 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.

scholarly journals Are general practitioners willing to deprescribe in oldest-old patients with polypharmacy?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K T Jungo ◽  
S Mantelli ◽  
Z Rozsnyai ◽  
E Reeve ◽  
R K E Poortvliet ◽  
...  
Keyword(s):  
General Practitioners ◽  
Online Survey ◽  
Oldest Old ◽  
Case Vignette ◽  
Old Patients ◽  
Factors Influencing ◽  
History Of ◽  
Public Health Challenge ◽  
Multimorbid Patients

Abstract Managing the growing number of oldest-old patients with multimorbidity and polypharmacy in primary health care poses an increasing public health challenge. Since inappropriate polypharmacy can harm patients’ health, general practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe. This case vignette study evaluates the deprescribing decisions of GPs from 31 countries and compares the factors influencing GPs’ deprescribing decisions. We invited GPs to participate in an online survey, containing a) three cases of increasingly dependent oldest-old multimorbid patients with potentially inappropriate polypharmacy and b) Likert-scale questions assessing the importance of factors influencing deprescribing. We presented each case with and without history of cardiovascular disease (CVD). For each case, we asked whether GPs would deprescribe any medication and, if so, which one(s). We calculated percentages of GPs deprescribing at least one medication in each case, compared cases with/without CVD history and different levels of dependency in activities of daily living, and calculated the percentage of factors rated as important or very important. Of 3175 invited GPs from 31 countries, 53% responded (N = 1’706) with a mean age of 50 years and 60% females. Results are preliminary, but despite some differences across GP characteristics (male/female, age) and across countries, GPs generally showed a high willingness to deprescribe in oldest-old patients (>80 years) with polypharmacy. GPs were more likely to deprescribe in patients with a higher level of dependency, in the absence of history of CVD, and when patients are on statins, proton-pump inhibitors or potentially inappropriate pain medication. Factors GPs rated as important or very important for the deprescribing decision were patients’ quality of life, risks and benefits of medications, patients’ life expectancy, and potential negative health outcomes resulting from deprescribing. Key messages Despite international differences, most GPs report they would deprescribe in older multimorbid patients with polypharmacy. The results will facilitate the development of interventions supporting general practitioners to deprescribe.

scholarly journals GP decisions to participate in emergencies: a randomised vignette study

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101153
Author(s):  
Magnus Hjortdahl ◽  
Dorte Gyrd-Hansen ◽  
Peder A. Halvorsen
Keyword(s):  
Confidence Interval ◽  
General Practitioners ◽  
Odds Ratio ◽  
Online Survey ◽  
Adjusted Odds Ratio ◽  
Team Training ◽  
Shortness Of Breath ◽  
Chi Square ◽  
Out Of Hours ◽  
Vignette Study

Background Little is known about how General Practitioners (GPs) decide whether to participate in emergencies. Aim To test whether GPs participation is associated with cause of symptoms, distance to the patient, other patients waiting and out of hours (OOH) clinic characteristics. Design and Setting Online survey to all Norwegian GPs (n = 4701). Method GPs were randomised to vignettes describing a patient with acute shortness of breath and asked if they would participate in a call-out. The vignettes varied with respect to cause of symptoms (trauma versus illness), distance to the patient (15 versus 45 minutes) and other patients waiting at the OOH clinic (crowding versus no crowding). The survey included questions about OOH clinic characteristics. Results Of the 1013 GPs (22%) that responded, 76% reported that they would participate. The proportion was higher in trauma (83% versus 69%, chi square 24.8, p < 0.001), short distances (80% versus 71%, chi square 9.5, p = 0.002) and no crowding (81% versus 70% chi square 14.6, p < 0.001). Participation was associated with availability of a manned response vehicle (adjusted odds ratio [OR] 2.06, 95% confidence interval [CI] 1.25-3.41), and team training at the OOH clinic once a year (OR 1.78, 95% CI 1.12-2.82) or more than once a year (OR 3.78, 95% CI 1.64-8.68). Conclusion GPs were less likely to participate when the incident was not due to trauma, was far away and when other patients were waiting. A manned response vehicle and regular team training were associated with increased participation.

scholarly journals Patient Characteristics and General Practitioners’ Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries

2019 ◽  
Vol 34 (9) ◽  
pp. 1751-1757 ◽  
Author(s):  
Milly A. van der Ploeg ◽  
Sven Streit ◽  
Wilco P. Achterberg ◽  
Erna Beers ◽  
Arthur M. Bohnen ◽  
...  
Keyword(s):  
General Practitioners ◽  
Oldest Old ◽  
Patient Characteristics ◽  
Survey Study ◽  
Old Patients

scholarly journals Correction to: How do Dutch general practitioners detect and diagnose atrial fibrillation? Results of an online case vignette study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Verbiest-van Gurp ◽  
D. van Mil ◽  
H. A. M. van Kesteren ◽  
J. A. Knottnerus ◽  
H. E. J. H. Stoffers
Keyword(s):  
Atrial Fibrillation ◽  
General Practitioners ◽  
Case Vignette ◽  
Vignette Study

scholarly journals How do Dutch general practitioners detect and diagnose atrial fibrillation? Results of an online case vignette study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
N. Verbiest - van Gurp ◽  
D. van Mil ◽  
H. A. M. van Kesteren ◽  
J. A. Knottnerus ◽  
H. E. J. H. Stoffers
Keyword(s):  
Atrial Fibrillation ◽  
General Practitioners ◽  
Case Vignette ◽  
Diagnostic Tools ◽  
Short Term ◽  
Vignette Study ◽  
Symptom Frequency ◽  
Case Vignettes ◽  
Almost All

Abstract Background Detection and treatment of atrial fibrillation (AF) are important given the serious health consequences. AF may be silent or paroxysmal and remain undetected. It is unclear whether general practitioners (GPs) have appropriate equipment and optimally utilise it to detect AF. This case vignette study aimed to describe current practice and to explore possible improvements to optimise AF detection. Methods Between June and July 2017, we performed an online case vignette study among Dutch GPs. We aimed at obtaining at least 75 responses to the questionnaire. We collected demographics and asked GPs’ opinion on their knowledge and experience in diagnosing AF. GPs could indicate which diagnostic tools they have for AF. In six case vignettes with varying symptom frequency and physical signs, they could make diagnostic choices. The last questions covered screening and actions after diagnosing AF. We compared the answers to the Dutch guideline for GPs on AF. Results Seventy-six GPs completed the questionnaire. Seventy-four GPs (97%) thought they have enough knowledge and 72 (95%) enough experience to diagnose AF. Seventy-four GPs (97%) could order or perform ECGs without the interference of a cardiologist. In case of frequent symptoms of AF, 36–40% would choose short-term (i.e. 24–48 h) and 11–19% long-term (i.e. 7 days, 14 days or 1 month) monitoring. In case of non-frequent symptoms, 29–31% would choose short-term and 21–30% long-term monitoring. If opportunistic screening in primary care proves to be effective, 83% (58/70) will support it. Conclusions Responding GPs report to have adequate equipment, knowledge, and experience to detect and diagnose AF. Almost all participants can order ECGs. Reported monitoring duration was shorter than recommended by the guideline. AF detection could improve by increasing the monitoring duration.

scholarly journals Competence of general practitioners in requesting and interpreting ECGs - a case vignette study

2018 ◽  
Vol 26 (7-8) ◽  
pp. 377-384 ◽  
Author(s):  
S. A. M. Compiet ◽  
R. T. A. Willemsen ◽  
K. T. S. Konings ◽  
H. E. J. H. Stoffers
Keyword(s):  
General Practitioners ◽  
Case Vignette ◽  
Vignette Study

scholarly journals Evaluation of general practitioners’ single-lead electrocardiogram interpretation skills: a case-vignette study

2020 ◽  
Author(s):  
Evert P M Karregat ◽  
Jelle C L Himmelreich ◽  
Wim A M Lucassen ◽  
Wim B Busschers ◽  
Henk C P M van Weert ◽  
...  
Keyword(s):  
General Practitioners ◽  
Detection Algorithm ◽  
Case Vignette ◽  
Vignette Study ◽  
Case Vignettes ◽  
Sensitivity Specificity ◽  
Electrocardiogram Interpretation ◽  
Ecg Abnormalities ◽  
Care Study ◽  
Rule Out

Abstract Background Handheld single-lead electrocardiograms (1L-ECG) present a welcome addition to the diagnostic arsenal of general practitioners (GPs). However, little is known about GPs’ 1L-ECG interpretation skills, and thus its reliability in real-world practice. Objective To determine the diagnostic accuracy of GPs in diagnosing atrial fibrillation or flutter (AF/Afl) based on 1L-ECGs, with and without the aid of automatic algorithm interpretation, as well as other relevant ECG abnormalities. Methods We invited 2239 Dutch GPs for an online case-vignette study. GPs were asked to interpret four 1L-ECGs, randomly drawn from a pool of 80 case-vignettes. These vignettes were obtained from a primary care study that used smartphone-operated 1L-ECG recordings using the AliveCor KardiaMobile. Interpretation of all 1L-ECGs by a panel of cardiologists was used as reference standard. Results A total of 457 (20.4%) GPs responded and interpreted a total of 1613 1L-ECGs. Sensitivity and specificity for AF/Afl (prevalence 13%) were 92.5% (95% CI: 82.5–97.0%) and 89.8% (95% CI: 85.5–92.9%), respectively. PPV and NPV for AF/Afl were 45.7% (95% CI: 22.4–70.9%) and 98.8% (95% CI: 97.1–99.5%), respectively. GP interpretation skills did not improve in case-vignettes where the outcome of automatic AF-detection algorithm was provided. In detecting any relevant ECG abnormality (prevalence 22%), sensitivity, specificity, PPV and NPV were 96.3% (95% CI: 92.8–98.2%), 68.8% (95% CI: 62.4–74.6%), 43.9% (95% CI: 27.7–61.5%) and 97.9% (95% CI: 94.9–99.1%), respectively. Conclusions GPs can safely rule out cardiac arrhythmias with 1L-ECGs. However, whenever an abnormality is suspected, confirmation by an expert-reader is warranted.

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