Factors associated with patient preferences towards deprescribing: a survey of adult patients on prescribed medications

  • Takuya Aoki
  • Yosuke YamamotoEmail author
  • Tatsuyoshi Ikenoue
  • Shunichi Fukuhara
Research Article


Background Deprescribing is a patient-centered intervention with inherent uncertainties and requires shared decision making and patient involvement. Objective In the present study, we aimed to investigate factors associated with patient preferences toward deprescribing in a representative sample in Japan. Methods We conducted a nationwide cross-sectional survey and used a quota sampling method to select representative samples of the Japanese general population. We collected data on participant demographic and clinical factors including the number of chronic health conditions and the number of regular prescription medications. Patients’ willingness to deprescribe was assessed using the patients’ attitudes towards deprescribing questionnaire. Multivariable logistic regression analyses were conducted to determine factors associated with the outcome measure. Results Data were analyzed for 1483 adult outpatients. The proportion of patients having willingness to deprescribe was 67.8%. After adjustment for age and gender, multimorbidity was significantly positively associated with patients’ willingness to deprescribe [adjusted odds ratio (aOR) 1.35; 95% confidence interval (CI) 1.06–1.72]. A similar association was found with polypharmacy (aOR 1.43; 95% CI 1.08–1.88). The number of visits to medical institutions and increasing age were also found to be associated with patients’ willingness to deprescribe. Conclusion Our study indicated that patient preferences towards deprescribing are consistent with the established clinical evidence regarding the efficacy of deprescribing for patients with multimorbidity and polypharmacy. These findings may be beneficial for health care providers to implement shared decision making regarding deprescribing effectively.


Chronic disease Decision making Deprescribing Japan Multimorbidity Patient preference Polypharmacy 



We thank the staff members of the Manami Imai (Nippon Research Centre) for their assistance with the administration of this study.



Conflicts of interest

Takuya Aoki, Yosuke Yamamoto, Tatsuyoshi Ikenoue, and Shunichi Fukuhara declare that they have no conflict of interest.


  1. 1.
    Reeve E, Thompson W, Farrell B. Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. Eur J Intern Med. 2017;38:3–11.CrossRefGoogle Scholar
  2. 2.
    Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of “deprescribing” with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254–68.CrossRefGoogle Scholar
  3. 3.
    Calderón-Larrañaga A, Poblador-Plou B, González-Rubio F, Gimeno-Feliu LA, Abad-Díez JM, Prados-Torres A. Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well? Br J Gen Pract. 2012;62(605):e821–6.CrossRefGoogle Scholar
  4. 4.
    Olsson IN, Runnamo R, Engfeldt P. Medication quality and quality of life in the elderly, a cohort study. Heal Qual Life Outcomes. 2011;9:95.CrossRefGoogle Scholar
  5. 5.
    Beer C, Hyde Z, Almeida OP, Norman P, Hankey GJ, Yeap BB, et al. Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study. Br J Clin Pharmacol. 2011;71(4):592–9.CrossRefGoogle Scholar
  6. 6.
    Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.CrossRefGoogle Scholar
  7. 7.
    Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016;353:1–6.Google Scholar
  8. 8.
    Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891.CrossRefGoogle Scholar
  9. 9.
    Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc. 2013;61(9):1508–14.CrossRefGoogle Scholar
  10. 10.
    Qi K, Reeve E, Hilmer SN, Pearson SA, Matthews S, Gnjidic D. Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Clin Pharm. 2015;37(5):949–57.CrossRefGoogle Scholar
  11. 11.
    Sirois C, Ouellet N, Reeve E. Community-dwelling older people’s attitudes towards deprescribing in Canada. Res Soc Adm Pharm. 2017;13(4):864–70.CrossRefGoogle Scholar
  12. 12.
    Ng WL, Tan MZW, Koh EYL, Tan NC. Deprescribing: what are the views and factors influencing this concept among patients with chronic diseases in a developed Asian community? Proc Singap Healthc. 2017;26(3):172–9.CrossRefGoogle Scholar
  13. 13.
    Tran V-T, Harrington M, Montori VM, Barnes C, Wicks P, Ravaud P. Adaptation and validation of the Treatment Burden Questionnaire (TBQ) in English using an internet platform. BMC Med. 2014;12(1):109.CrossRefGoogle Scholar
  14. 14.
    Aoki T, Yamamoto Y, Ikenoue T, Onishi Y, Fukuhara S. Multimorbidity patterns in relation to polypharmacy and dosage frequency: a nationwide, cross-sectional study in a Japanese population. Sci Rep. 2018;8(1):3806.CrossRefGoogle Scholar
  15. 15.
    Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–95.CrossRefGoogle Scholar
  16. 16.
    Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol. 1998;51(11):1037–44.CrossRefGoogle Scholar
  17. 17.
    Fukuhara S, Ware JE, Kosinski M, Wada S, Gandek B. Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol. 1998;51(11):1045–53.CrossRefGoogle Scholar
  18. 18.
    Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Development and validation of the patients’ attitudes towards deprescribing (PATD) questionnaire. Int J Clin Pharm. 2013;35(1):51–6.CrossRefGoogle Scholar
  19. 19.
    Reeve E, Low LF, Shakib S, Hilmer SN. Development and validation of the revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire: versions for older adults and caregivers. Drugs Aging. 2016;33(12):913–28.CrossRefGoogle Scholar
  20. 20.
    Galazzi A, Lusignani M, Chiarelli MT, Mannucci PM, Franchi C, Tettamanti M, et al. Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy. Int J Clin Pharm. 2016;38(2):1–8.CrossRefGoogle Scholar
  21. 21.
    Nobili A, Garattini S, Mannucci P. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorbidity. 2011;1(1):28–44.CrossRefGoogle Scholar
  22. 22.
    Mannucci PM, Nobili A, REPOSI Investigators. Multimorbidity and polypharmacy in the elderly: lessons from REPOSI. Intern Emerg Med. 2014;9(7):723–34.CrossRefGoogle Scholar
  23. 23.
    Steinman MA, Seth Landefeld C, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516–23.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Institute for Health Outcomes and Process Evaluation Research (iHope International)KyotoJapan
  3. 3.Human Health SciencesKyoto University Graduate School of MedicineKyotoJapan
  4. 4.Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR)Fukushima Medical UniversityFukushimaJapan
  5. 5.Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE)Fukushima Medical UniversityFukushimaJapan

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