Older Patient and Surrogate Attitudes Toward Deprescribing During the Transition From Acute to Post-Acute Care

Abstract

Attitudes toward deprescribing among hospitalized older patients transitioning to post-acute care in the United States are less known. This study describes older patients' and their surrogate's attitudes using all items of the Patient Attitudes Toward Deprescribing (PATD) questionnaire and compares perceived pill burden to the actual count of total daily pills and potentially inappropriate medications (PIMs). Overall, 93% of participants were willing to deprescribe if their physician agreed. Compared to patients, surrogates had 64% reduced odds (95% CI: 0.18-0.74) of believing that all of the care recipient's medications were necessary and 61% reduced odds (95% CI: 0.17-0.88) of attributing cost as a factor in deprescribing. Perceptions of medication burden were associated with patients' total daily pills (median 16) and PIMS (median 7), yet 61% agreed that all their medicines were necessary. Patients and surrogates typically express a willingness to deprescribe but have differing perceptions of medication appropriateness.

Trial registration: ClinicalTrials.gov NCT02979353.

Keywords: assessment; care transitions; medication burden; polypharmacy.

Figures 1

a-c. Box-and-whisker plots of the counts of pre-hospital pills per day, stratified by response to PATD questions 1, 12, and 13 and whether the survey was completed by the patient or surrogate. Linear regression was used to test the associations of daily pill count versus PATD response, patient/surrogate status, and their interaction (i.e., is the association between pill count and PATD response different for patients versus surrogates?). Categories presented on the X-axis are the response categories participants were provided from the original version of the PATD.

Figures 1

a-c. Box-and-whisker plots of the counts of pre-hospital pills per day, stratified by response to PATD questions 1, 12, and 13 and whether the survey was completed by the patient or surrogate. Linear regression was used to test the associations of daily pill count versus PATD response, patient/surrogate status, and their interaction (i.e., is the association between pill count and PATD response different for patients versus surrogates?). Categories presented on the X-axis are the response categories participants were provided from the original version of the PATD.

Figures 1

a-c. Box-and-whisker plots of the counts of pre-hospital pills per day, stratified by response to PATD questions 1, 12, and 13 and whether the survey was completed by the patient or surrogate. Linear regression was used to test the associations of daily pill count versus PATD response, patient/surrogate status, and their interaction (i.e., is the association between pill count and PATD response different for patients versus surrogates?). Categories presented on the X-axis are the response categories participants were provided from the original version of the PATD.