BACKGROUND: General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS: In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS: Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION: The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.

Clinical Medicine Faculty of Medicine and Health Technology Tampere University Tampere Finland

Danish College of General Practitioners Copenhagen Denmark

Department of Clinical Sciences Centre for Primary Health Care Research Lund University Malmö Sweden

Department of Family Medicine Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education Kyiv Ukraine

Department of Family Medicine Medical Faculty University of Ljubljana Ljubljana Slovenia

Department of Family Medicine Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Department of Family Medicine Semmelweis University Budapest Hungary

Department of Family Medicine University of Tartu Tartu Estonia

Department of General Internal Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of General Practice and Family Medicine Center for Public Health Medical University of Vienna Vienna Austria

Department of General Practice Faculty of Medicine University of Leipzig Leipzig Germany

Department of Internal Medicine Section Gerontology and Geriatrics Leiden University Medical Center Leiden the Netherlands

Department of Medical Informatics Hôpital Européen Georges Pompidou AP HP Paris France

Department of Medicine and Optometry Linnaeus University Kalmar Sweden

Department of Nephrology and Department of Family Medicine University Clinical Centre University St Cyril and Metodius Skopje Macedonia

Department of Nursing and Midwifery University Antwerp Antwerp Belgium

Department of Primary and Interdisciplinary Care University Antwerp Antwerp Belgium

Department of Public Health and Primary Care Leiden University Medical Center Leiden the Netherlands

Department of Social Medicine Charles University Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic

Department of Urology and General Medicine Faculty of Medicine Medical University of Plovdiv Plovdiv Bulgaria

Dom zdravlja Zagreb Centar Zagreb Croatia

Faculty of Medicine Department of Family Medicine Riga Stradiņs University Riga Latvia

Family Doctor Invited Assistant of the Department of Family Medicine NOVA Medical School Lisbon Portugal

Family Medicine Department Medical School University of Tuzla Tuzla Bosnia and Herzegovina

Family Medicine Department Wroclaw Medical University Wrocław Poland

Geriatric Medicine Research Faculty of Medicine and College of Pharmacy Dalhousie University and Nova Scotia Health Authority Halifax NS Canada

Hannover Medical School Center for Public Health and Healthcare Hannover Germany

Hospital Israelita Albert Einstein São Paulo Brazil

INSERM Université de Paris Sorbonne Université Centre de Recherche des Cordeliers Information Sciences to support Personalized Medicine F 75006 Paris France

Institute for General Practice University of Duisburg Essen University Hospital Essen Essen Germany

Institute for Health and Behaviour Research Unit INSIDE University of Luxembourg Luxembourg Luxembourg

Institute of General Practice and Family Medicine University of Bonn Bonn Germany

Institute of Primary Health Care University of Bern Bern Switzerland

Irish College of General Practitioners Dublin Ireland

Primary Care Clinical Unit the University of Queensland Brisbane Australia

Primary Community and Social Care Keele University Keele Staffordshire ST5 5BG United Kingdom

Quality Use of Medicines and Pharmacy Research Centre UniSA Clinical and Health Sciences University of South Australia Adelaide South Australia Australia

Research Unit for General Medicine and Primary Health Care Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece

Romanian Society of Family Medicine Bucharest Romania

SSLMG Societé Scientifique Luxembourgois en Medicine generale Luxembourg City Luxembourg

UWV Leiden the Netherlands

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