Abstract

Background

Deprescribing (planned, supervised discontinuation) of statins may be considered in some older persons. This should be carefully discussed between patients and GPs.

Methods

We examined GPs’ preferences for discussing statin deprescribing by conducting a discrete choice experiment (DCE) sent to a stratified random sample of 500 Danish GPs. Attributes were discussion topics (goals of therapy, evidence on statin use in older persons, adverse effects, uncertainty), and levels were the depth of the discussion topics (none, brief, detailed). We used mixed logistic regression for analysis.

Results

A total of 90 GPs (mean age 48, 54% female, mean 11 years in practice) completed the DCE. There was substantial variability in which topics GPs felt were most important to discuss; however, GPs generally preferred a brief discussion of topics to detailed ones. The most important discussion topic appeared to be goals of therapy. GPs felt a brief discussion of evidence was important but not a detailed one, while adverse effects and uncertainty were felt to be less important to discuss.

Conclusion

GPs prefer brief discussions on a range of topics when discussing statin deprescribing but have differing views on which topics are most important. For deprescribing communication tools to be useful to GPs in clinical practice, they may need to focus on brief coverage of the range of relevant topics. Future work should evaluate patient preferences, and opportunities for education and training for GPs on deprescribing communication.

中文翻译：

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讨论他汀类药物处方的 GP 偏好：离散选择实验

摘要

背景

一些老年人可能会考虑开具他汀类药物的处方（计划的、有监督的停药）。这应该在患者和全科医生之间仔细讨论。

方法

我们通过发送给 500 名丹麦 GP 的分层随机样本的离散选择实验 (DCE) 来检查 GP 讨论他汀类药物处方的偏好。属性是讨论主题（治疗目标、他汀类药物在老年人中使用的证据、不良反应、不确定性），水平是讨论主题的深度（无、简短、详细）。我们使用混合逻辑回归进行分析。

结果

共有 90 名全科医生（平均年龄 48 岁，54% 女性，平均 11 年实践）完成了 DCE。全科医生认为最重要的讨论主题存在很大差异；然而，全科医生通常更喜欢对主题进行简短讨论，而不是详细讨论。最重要的讨论主题似乎是治疗目标。全科医生认为对证据的简短讨论很重要，但不是详细的讨论，而不利影响和不确定性则被认为不太重要。

结论

在讨论他汀类药物的处方时，全科医生更喜欢对一系列主题进行简短讨论，但对哪些主题最重要有不同的看法。为了描述在临床实践中对全科医生有用的沟通工具，他们可能需要专注于对相关主题范围的简要介绍。未来的工作应该评估患者的偏好，以及对全科医生进行关于禁止沟通的教育和培训的机会。