Deprescribing Decisions in Swiss Primary Care: Low Concordance Between General Practitioners and Older Adults

Background

Deprescribing reduces potentially harmful or unnecessary medications in older adults. Successful implementation requires understanding both patient and provider perspectives, although few studies have compared their preferences.

Objective

To examine general practitioner (GP) and patient preferences for deprescribing and medication-related decision-making by investigating factors associated with preference concordance and the relationship with patient-provider trust.

Design

Cross-sectional survey study conducted in primary care settings within the German-speaking region of Switzerland.

Participants

Sixty-five patients aged ≥ 65 years taking ≥ 5 medications and their 10 GPs completed questionnaires.

Main Measures

Patient and GP preferences for deprescribing medications were assessed through two questions; for patients: “Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?” and for GPs: “Would you stop or reduce the dose of any of the medications that the patient is currently taking?” We assessed concordance between GPs’ and patients’ deprescribing preferences and analyzed associations between trust and deprescribing preferences using univariate Generalized Estimating Equations with Poisson distribution and finite-sample correction, accounting for clustering at the GP level.

Key Results

Similar proportions of patients (38%) and GPs (35%) wanted to deprescribe at least one medication, but only eight GP-patient dyads wanted to deprescribe, with just one dyad selecting the same medication. The most frequently identified medications to deprescribe were dietary supplements (GPs = 11/42, 26%; patients = 4/35, 11%), cardiovascular system medications (GPs = 9/42, 21%; patients = 15/35, 43%), and nervous system medications (GPs = 8/42, 19%; patients = 9/35, 26%). GPs’ primary reason for not deprescribing was believing patients wanted to continue their medications (83%), while patients believed doctors only prescribe necessary ones (38%).

Conclusions

Despite similar interest in deprescribing, GPs and patients rarely selected the same medications to stop. These findings suggest that clear discussions about medication necessity and preferences could improve deprescribing decisions.