Short summary

We will investigate what patients feel is important to discuss with their physician when discontinuing medication. This study will focus on the discontinuation of proton pump inhibitors (PPIs) and statins. Semi-structured interviews (approximately n=20) will be conducted with persons age 65+ taking PPIs who either have no indication for long-term use or who have previously discontinued PPIs as well as persons age 80+ taking statins or who have previously discontinued statins. The interviews will be analyzed to identify different factors which are important to patients when discussing discontinuation of medication.  

Rationale

There is an increased focus on patient safety and the understanding of use of potential inappropriate medication among older persons. The discussion about discontinuing potential inappropriate medication should be carried out through shared decision making in consultation with the prescriber. Today there are minimal understanding of what patients feel would be important to discuss with a prescriber when considering discontinuation of medications.  

Two examples of potentially inappropriate medications are proton pump inhibitors (PPIs) continued long-term and statins in frail older persons.

PPIs work by lowering the acid in the stomach and is e.g. used in the treatment of ulcers and acid reflux. Long-term use of PPIs is often seen in older people with no indications for long-term use. Furthermore, long-term use with high doses PPIs is associated with increased risk of infection with the bacteria Clostridium difficile and hip fracture among older people. If there is no indication for long-term use of PPI, it should be considered discontinued through shared decision making with the prescriber.    

Statins lowers the cholesterol in the blood and is among other used to reduce the risk of cardiovascular diseases. There is limited evidence of the effect of treatment with statins in older people age 80+, especially those with comorbidities. The clinical effect will first appear after long-term use. The treatment should be individualized based on the patient's clinical status, cardiovascular status, and treatment goals. This makes it relevant for the patient to discuss discontinuation of the treatment with their prescriber.    

The aim of this study is to investigate what patients feel would be important when discussing discontinuation medications with their physician.

Description of the cohort

There will be two different populations.

Proton pump inhibitors (PPIs): Persons age 65+ taking PPIs who either have no indication for long-term use or who have previously discontinued PPIs (n=10). 

Statins: Persons age 80+ taking statins or who have previously discontinued statins (n=10).

Data and biological material

Interview answers containing information about patients' attitudes towards discussing deprescribing. 

Furthermore, we will collect data about personal information (sex, age, and place of residence) and health information (medication, including treatment duration and indication). 

Collaborating researchers and departments

Department of Public Health, University of Southern Denmark

• Master Student, Malene Nissen
• Master Student Ida Theemann Jacobsen
• Department of Public Health, University of Southern Denmark, Clinical Pharmacist, PhD, Anton Pottegård
• Clinical Pharmacist, PhD Student, Wade Thompson