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Research

GPs’ mindlines around deprescribing antihypertensives in older patients with multimorbidity: qualitative study

Karolina Kuberska, Fiona Scheibl, Carol Sinnott, James Sheppard, Mark Lown, Marney Williams, Rupert Payne, Jonathan Mant, Richard McManus and Jenni Burt
British Journal of General Practice 22 December 2020; bjgp21X714305. DOI: https://doi.org/10.3399/bjgp21X714305
Karolina Kuberska
1 The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
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Fiona Scheibl
2 Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Carol Sinnott
1 The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
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James Sheppard
3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Mark Lown
4 Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
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Marney Williams
5 Patient and Public Involvement Representative, London, United Kingdom
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Rupert Payne
6 Centre for Academic Primary Care, University of Bristol, Bristol, United Kingdom
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Jonathan Mant
7 Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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Richard McManus
8 Nuffield Department of Primary Care Health Sciences, University of Oxford Medical Sciences Division, Oxford, United Kingdom
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Jenni Burt
9 The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
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  • For correspondence: jenni.burt@thisinstitute.cam.ac.uk
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Abstract

Background: Optimal management of hypertension in older patients with multimorbidity is a cornerstone of primary care practice. Despite emphasis on personalised approaches to treatment in older patients, there is little guidance on how to achieve medication reduction when GPs are concerned that possible risks outweigh potential benefits of treatment. Mindlines – tacit, internalised guidelines developed over time from multiple sources – may be of particular importance in such situations. Aim: To explore GPs’ decision-making on deprescribing antihypertensives in multimorbid patients over 80 years old, drawing on the concept of mindlines. Design: Qualitative interview study. Setting: English general practice. Methods: Thematic analysis of face-to-face interviews with a sample of 15 GPs from 7 practices in the East of England, using a chart-stimulated recall approach to explore approaches to treatment for older multimorbid patients with hypertension. Results: GPs are typically confident making decisions to deprescribe antihypertensive medication in older multimorbid patients when prompted by a trigger, such as a fall or adverse drug event. GPs are less confident to attempt deprescribing in response to generalised concerns about polypharmacy, and work hard to make sense of multiple sources (including available evidence, shared experiential knowledge, and non-clinical factors) to guide decision-making. Conclusion: In the absence of a clear evidence base on when and how to attempt medication reduction in response to concerns about polypharmacy, GPs develop ‘mindlines’ over time through practice-based experience. These tacit approaches to making complex decisions are critical to developing confidence to attempt deprescribing, and may be strengthened through reflective practice.

  • Clinical (physical)
  • Cardiovascular disease
  • Hypertension
  • Received February 26, 2020.
  • Accepted October 16, 2020.
  • Copyright © 2020, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
GPs’ mindlines around deprescribing antihypertensives in older patients with multimorbidity: qualitative study
Karolina Kuberska, Fiona Scheibl, Carol Sinnott, James Sheppard, Mark Lown, Marney Williams, Rupert Payne, Jonathan Mant, Richard McManus, Jenni Burt
British Journal of General Practice 22 December 2020; bjgp21X714305. DOI: 10.3399/bjgp21X714305

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Accepted Manuscript
GPs’ mindlines around deprescribing antihypertensives in older patients with multimorbidity: qualitative study
Karolina Kuberska, Fiona Scheibl, Carol Sinnott, James Sheppard, Mark Lown, Marney Williams, Rupert Payne, Jonathan Mant, Richard McManus, Jenni Burt
British Journal of General Practice 22 December 2020; bjgp21X714305. DOI: 10.3399/bjgp21X714305
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Keywords

  • Clinical (physical)
  • Cardiovascular disease
  • Hypertension

More in this TOC Section

  • The experience of implementing and delivering group consultations in UK general practice
  • A smoking cessation intervention in Australian General Practice: secondary analysis of a cluster randomised controlled trial
  • GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study
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Print ISSN: 0960-1643
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