Potentially inappropriate medication in primary care at the end of life: a mixed-method study

Abstract

Context: Polypharmacy results in adverse drug interactions, high pill burden, and medication costs. Stopping or diminishing potentially inappropriate medication (PIM), is complex . Data on the use of PIM in a primary care context are scarce and deprescribing barriers for general practitioners (GP) are underexplored.

Objective: Describing the use of PIM in primary care at the end of life, and exploring the barriers for GPs to deprescribe.

Methods: Retrospective chart review of 210 consecutive patients referred to a palliative home care service and semi-structured interviews with 11 GPs. Percentages were calculated on medication use, linear regression was done to evaluate the effect of diagnosis on PIM use. Thematic analysis was used to analyze the interviews.

Results: In total 83 % of patients took at least one PIM. The proportion that continued taking PIMs at the time of referral, one week prior to death and at the day of dying: varies between 6% and 45% according to drug category. Linear regression showed a statistical significant (p < 0.001) higher number of PIM use with non-cancer patients (mean 3,1–SD 1,5) than with cancer patients (mean 1,6–SD 1,6). Participants reported being aware of the PIM use, making efforts to deprescribe. Main issues GPs are taking into account are medical, communicative, and collaborative in nature.

Conclusion: This study confirms the high level of PIM use in primary care at the end of life. The views of GPs inspire support strategies for deprescribing focusing on shared decision-making with patients and on interprofessional collaboration.

Keywords:

• Palliative care
• primary care
• potentially inappropriate medication
• deprescribing
• medical futility
• end of life