Article Text
Abstract
Objectives To explore general practitioners’ (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support.
Design Semistructured interviews.
Setting Dutch general practice.
Participants Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached.
Results GPs appeared reluctant to start AHM, especially in patient >80 years. High systolic blood pressure and history of cardiovascular disease or diabetes were enablers to start or intensify treatment. Reasons to refrain from this were frailty and patient preference. GPs described a tendency to continue AHM regimens unchanged, influenced by daily time constraints, automated prescription routines and anticipating discomfort when disturbing patients’ delicate balance. GPs were only inclined to deprescribe AHM in terminally ill patients or after prolonged achievement of target levels in combination with side effects or patient preference. Deprescription was facilitated when GPs had experience with patients showing increased quality of life after deprescription and was withheld by anticipated regret (ie, GPs’ fear of a stroke after deprescribing). GPs felt insufficient guidance from current guidelines, especially on deprescription.
Conclusions GPs are reluctant to start or deprescribe AHM in older people and have a propensity to continue AHM within a daily routine that insufficiently supports critical medication review. (De)prescription is influenced by patient preferences and anticipated regret and current guidelines provide insufficient guidance.
- drug prescriptions
- antihypertensive agents
- blood pressure
- general practice
- qualitative research
- deprescriptions
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Footnotes
Contributors TvanM: study design, data acquisition, data analysis, data interpretation, drafting the manuscript. SDI: data acquisition, data analysis, data interpretation, critical revision of manuscript. PGvanP and RKEP: data interpretation, critical revision of manuscript. ER, AJP and EMvanC: study design, data interpretation, critical revision of manuscript.
Funding The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 305374 and an EU Joint Programme—Neurodegenerative Disease Research (JPND) project. The JPND project is supported through the following funding organisations under the aegis of JPND—www.jpnd.eu: Finland, Suomen Akatemia (Academy of Finland,291803); France, L’Agence Nationale de la Recherche (The French National Research Agency, ANR-14-JPPS-0001-02); Germany, Bundesministerium für Bildung und Forschung (BMBF) (The Federal Ministry of Education and Research, FKZ01ED1509); Sweden, Vetenskapsrådet (VR) (Swedish Research Council, 529-2014-7503), The Netherlands, ZonMw (The Netherlands Organization for Health Research and Development, 733051041).
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data will not be made publicly available. For more information, please contact the corresponding author.