The Elderly’s Thoughts and Attitudes about Polypharmacy and Deprescribing: A Qualitative Pilot Study in Portugal

Round 1

Reviewer 1 Report

In my opinion, the article is   for publication.suitable.  I raises important issuses related to gerontology.

I only have one comment: reference 31 is has been published in 1997. Please remove it or replace it with newer reference.

Author Response

Thank you for your comment, the mentioned reference was removed.

Reviewer 2 Report

The subject matter discussed in the article is important and up- to - date. However , the presented research results can be treated as pilot study only. The article does not specyfy any hypothesses that will be verified. Therefore, it is suggest to complete the article with hypothesses. In order to increase the cognitive and substantive value of the article,the research should be carried out in a larger group of elderly patients as well in other healths care center in Portugalia. In addition, patients should assess the importance of barriers and enablers.  Then the conclussion of the research may be more helpful for health care centre.   

Author Response

Thanks for your comment.

We changed the title to mention that it is a pilot study.

We added a hypothesis to the article: "From the literature review, we hypothesized that many factors may influence the management of polypharmacy and deprescription, either related to the elderly’s attitudes and ideas, the doctor-patient relationship, and the health professional’s own barriers and enablers."

Reviewer 3 Report

Reviewer’s Comment:

This is a great topic!  Unfortunately, the sample size of 11 is too small.  For that reason alone, I must recommend a rejection of the article.

However, I have other concerns:

How did these patients decide, if their drugs are in fact appropriate or not? I believe this study should be a focus group of either physicians who prescribe these drugs or pharmacists who dispense these drugs.  If pharmacists were performing Medication Therapy Management (MTM), then poly pharmacy, as well as inappropriate medication use, would be reduced, if not eliminated.

Specifically about the article, I have the following comments:

1.       These elderly people are not nursing home residents, correct?  They live independently?

2.       How did the authors identify the “Core Dimensions” and “Sub Categories”? Was that based on literature review? Not clear.

3.       I also understand that participants’ comments are reported verbatim, but they are difficult to understand.  May be they should be paraphrased for better understanding.

4.       How would the patients know if the medication is working or not.  There are a number of diseases, for example, hypertension, which are considered “silent killer.”  And the patient may not understand if the anti-hypertensive drug is working.  However, if blood pressure is reduced or is under control, then the drug is working, correct?

5.       I agree with the authors – the health professionals have the greatest influence here.  Patients should not suddenly stop taking their drugs without their physician or pharmacist’s prior approval.

6.       However, making elderly patients aware of “Poly Pharmacy” is a great idea – but that was not the focus of this study.

7.       I believe Portugal has a health care system with universal coverage (with government as the main payer).  Hence, government organizations should be interested to decrease “Poly Pharmacy” and un-necessary use of drugs.  Because this in turn will reduce health care cost.

Although I agree that this is an important topic, the article does not merit publication.

Author Response

Thanks for your comments.

1- Yes, the participants were not nursing home residents. They lived independently.

2- As mentioned in Methods, we based on the literature review ("We based our codification in seven core themes (appropriateness, process, influences, fear, dislike, cost and habit) and correspondent subthemes from two frameworks [11,14].") and all themes that we could extract from our focus group could be placed in one of them.

4- We wanted to know their perception of the impact of their medication. Some reported that they thought they no longer needed the medication because the symptons that prompted the prescription of those medications had already disappeared or their blood pressure was normal, so they thought that the problem was solved and they could reduce or stop the medication. It reflects how different the perception of the impact of the medications is between doctors and patients.