Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents.

BACKGROUND/OBJECTIVES: Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents. DESIGN: Interview-based questionnaire study. SETTING: Denmark. PARTICIPANTS: Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation-Memory-Concentration score of ≥8. MEASUREMENTS: Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics. RESULTS: Participants had a median age of 82 years (interquartile range [IQR] 76-89) and used a median of 8 medications (IQR 5-10). Thirty-three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden" score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median "involvement" score 80 vs 75, p < 0.05) and geriatric inpatients (median "involvement" score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased "burden" score (ptrend = 0.001): Those using 1-4 medications daily had a median score of 25 (IQR 17-33) compared to 58 (IQR 42-75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping" score (ptrend  = 0.001) and a lower "appropriateness" score (ptrend < 0.001), respectively. CONCLUSION: Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.

[The Swedish specialist examination in emergency medicine: reflections on the first decade]. / Svensk specialisttentamen i akutsjukvård: 10 års perspektiv - Med slutgiltigt mål att förbättra vården för patienterna på Sveriges akutmottagningar.

Emergency Medicine became a supraspeciality in Sweden in 2008. The Swedish Specialist Examination in Emergency Medicine is a formative examination that seeks to guide local training in Emergency Medicine, provide feedback to physicians during their residency, and establish national standards for various processes in Emergency Medicine. It consists of six partial examinations and 118 cases. Documents and checklists accessible on the internet specify the degree of competence expected during the examination. Program directors are tasked with offering the examination locally to their residents. During the past 10 years, the examination has been offered during 53 days to 180 residents belonging to 27 training programs. The total number of passed partial examinations is 201. Six physicians have so far passed all six partial examinations.