Patients' Attitudes Towards Deprescribing Differ Across Specific Cardiovascular and Diabetes Medication: A Survey Study Assessing Within‐Patient Differences

TL;DR

Older patients have different attitudes about stopping specific medications like statins, antihypertensives, sulfonylureas, and insulins, which could affect deprescribing discussions.

Contribution

This study reveals within-patient differences in attitudes toward deprescribing specific cardiovascular and diabetes medications.

Findings

Patients considered sulfonylureas and insulins more appropriate for deprescribing than statins and antihypertensives.

No significant differences were found in concerns about deprescribing across the medications.

The findings suggest medication-specific attitudes should be considered in deprescribing discussions.

Abstract

Knowing whether patients' attitudes towards deprescribing differ by medication is important for implementing deprescribing in practice.

To assess whether there are within‐patient differences in attitudes towards deprescribing the following cardiovascular and diabetes medications: statins, antihypertensives, sulfonylureas and insulins.

We administered the revised Patient Attitudes Towards Deprescribing questionnaire to Dutch primary care patients. The ‘appropriateness’ and ‘concerns’ factors were adapted to measure medication‐specific attitudes. Pairwise comparisons of appropriateness and concerns factor scores were tested with Wilcoxon signed‐rank tests and corrected to control the false discovery rate.

Responses from 160 patients (median age: 79 years, 34% frail) were used for the comparisons. Appropriateness factor scores were higher for insulins compared to statins (n = 18, 3.9 versus 3.3, p < 0.031), antihypertensives (n = 21, 4.0 versus 3.6, p < 0.031) and sulfonylureas (n = 12, 3.8 versus 3.4, p < 0.031) and higher for sulfonylureas compared to antihypertensives (n = 26, 3.6 versus 3.4, p = 0.036) and statins (n = 27, 3.6 versus 3.2, p = 0.006). No statistical differences were found for the concerns factor scores.

Given the observed differences in appropriateness attitudes, patients may be more positive towards deprescribing statins and antihypertensives as compared to sulfonylureas and particularly insulins. Healthcare providers should be aware that patients can experience medication‐specific barriers when discussing options for deprescribing.

This study explored whether older patients feel differently about stopping specific cardiovascular and diabetes medications. Using a questionnaire, 160 older adults shared their views on potentially deintensifying their statins, antihypertensives, sulfonylureas and insulins. Comparisons were made among small groups of patients using multiple of these medications. Patients considered their sulfonylureas and especially their insulins relatively more appropriate than their statins and antihypertensives, but did not have more concerns when stopping these medications. Clinicians should consider these differences when discussing options to deintensify treatment with patients to ensure a patient‐centred deprescribing process.

Figures