Attitudes, Beliefs, and Experiences Regarding Polypharmacy
Attitudes, Beliefs, and Experiences Regarding Polypharmacy
One hundred seven individuals were approached for participation in this study. Seven refused or were not able to complete the questionnaire, resulting in 100 participants who answered all 15 questions of the PATD. (Participant characteristics are reported in Table 1.) Participants were aged 20 to 91 (median 71.5, interquartile range (IQR) 60–80) with a median of six medical conditions (IQR 4–8) and 10 medications (IQR 7–13), equalling approximately 1.5 medications per medical condition. Eighty-six percent of participants had cardiovascular disease (37% congestive cardiac failure, 38% ischemic heart disease, 65% hypertension, 46% hyperlipidemia), 29% had diabetes mellitus, and 26% had asthma or chronic obstructive pulmonary disease. The number of regular medications (P < .001), minimum number of tablets or capsules taken per day (P = .03), and number of medical conditions (P = .001) all increased with age. The 65 participants aged 65 and older had a median of 7 medical conditions (IQR 5–9) and took 11 medications (IQR=8–14).
Table 2 and Table 3 show the responses to the questionnaire. Sixty-five percent (95% CI = 55.7–74.4) of participants agreed that they were taking a large number of medications, 92% (95% CI = 86.7–97.3) reported that they would be willing to stop a regular medication if their physician informed them that it was possible, and 68% (95% CI = 58.9–77.1) reported that they had a desire to reduce the number of medications that they were currently taking; 78% (95% CI = 69.9–86.1) of participants felt that all their regular medications were necessary, and 16% (95% CI = 8.8–23.2) felt that they were taking a medication that they no longer needed.
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Table 3.
Results from Questions 11 to 15 of the Patients' Attitudes Towards Deprescribing Questionnaire
There was a significant relationship between age and agreement with two of the questions, such that older participants were more likely to agree that "I feel that I am taking a large number of medications" (73% vs 51%, P = .02) and that "I feel that I may be taking one or more medications that I no longer need" (18% vs 11%, P = .047).
Willingness to stop a medication was positively correlated with a desire to take fewer medications (gamma (G) = 0.353, P = .01) but had no relationship to any other questions, including the feeling of taking a large number of medications and previous experience with cessation of a regular medication. Desire to stop a medication was correlated with the feeling of taking a large number of medications (G = 0.491, P < .001) and being less comfortable with current medications (G = −0.364, P = .005). Experiencing a side effect was negatively correlated with comfort with medications (G = −0.326, P = .02) and positively correlated with perceived lack of need for one (or more) current medications (G = 0.423, P = .001). There was no correlation between experiencing a side effect and willingness (P = .61) or desire (P = .06) to stop a medication.
Age, number of regular medications, number of medical conditions, and use of a DAA did not influence willingness to cease a medication, but participant possession of a medication discount card and physician trust score had a significant association with their response to this question. Possession of a medication discount card was correlated with less willingness to stop a medication (P = .048) and a higher physician trust score was correlated with greater willingness to stop a medication (P = .05). When younger participants were removed from the analysis, all of the associations above were still present, although the statistical significance for some was lost.
Results
Participant Characteristics
One hundred seven individuals were approached for participation in this study. Seven refused or were not able to complete the questionnaire, resulting in 100 participants who answered all 15 questions of the PATD. (Participant characteristics are reported in Table 1.) Participants were aged 20 to 91 (median 71.5, interquartile range (IQR) 60–80) with a median of six medical conditions (IQR 4–8) and 10 medications (IQR 7–13), equalling approximately 1.5 medications per medical condition. Eighty-six percent of participants had cardiovascular disease (37% congestive cardiac failure, 38% ischemic heart disease, 65% hypertension, 46% hyperlipidemia), 29% had diabetes mellitus, and 26% had asthma or chronic obstructive pulmonary disease. The number of regular medications (P < .001), minimum number of tablets or capsules taken per day (P = .03), and number of medical conditions (P = .001) all increased with age. The 65 participants aged 65 and older had a median of 7 medical conditions (IQR 5–9) and took 11 medications (IQR=8–14).
Responses to the PATD Questionnaire
Table 2 and Table 3 show the responses to the questionnaire. Sixty-five percent (95% CI = 55.7–74.4) of participants agreed that they were taking a large number of medications, 92% (95% CI = 86.7–97.3) reported that they would be willing to stop a regular medication if their physician informed them that it was possible, and 68% (95% CI = 58.9–77.1) reported that they had a desire to reduce the number of medications that they were currently taking; 78% (95% CI = 69.9–86.1) of participants felt that all their regular medications were necessary, and 16% (95% CI = 8.8–23.2) felt that they were taking a medication that they no longer needed.
(Enlarge Image)
Table 3.
Results from Questions 11 to 15 of the Patients' Attitudes Towards Deprescribing Questionnaire
There was a significant relationship between age and agreement with two of the questions, such that older participants were more likely to agree that "I feel that I am taking a large number of medications" (73% vs 51%, P = .02) and that "I feel that I may be taking one or more medications that I no longer need" (18% vs 11%, P = .047).
Relationships of Responses Within the PATD Questionnaire
Willingness to stop a medication was positively correlated with a desire to take fewer medications (gamma (G) = 0.353, P = .01) but had no relationship to any other questions, including the feeling of taking a large number of medications and previous experience with cessation of a regular medication. Desire to stop a medication was correlated with the feeling of taking a large number of medications (G = 0.491, P < .001) and being less comfortable with current medications (G = −0.364, P = .005). Experiencing a side effect was negatively correlated with comfort with medications (G = −0.326, P = .02) and positively correlated with perceived lack of need for one (or more) current medications (G = 0.423, P = .001). There was no correlation between experiencing a side effect and willingness (P = .61) or desire (P = .06) to stop a medication.
Influence of Individual Characteristics on Willingness to Cease Medications
Age, number of regular medications, number of medical conditions, and use of a DAA did not influence willingness to cease a medication, but participant possession of a medication discount card and physician trust score had a significant association with their response to this question. Possession of a medication discount card was correlated with less willingness to stop a medication (P = .048) and a higher physician trust score was correlated with greater willingness to stop a medication (P = .05). When younger participants were removed from the analysis, all of the associations above were still present, although the statistical significance for some was lost.
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