General practitioners’ insight into deprescribing for the multimorbid older individual: a qualitative study

Ailabouni, Nagham; Nishtala, Prasad S.; Mangin, Dee; Tordoff, June

doi:10.1111/ijcp.12780

Cited by 51 publications

(88 citation statements)

References 68 publications

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“…[21][22][23][24][25][26][27][28][29][30] Many of the suggested organizational changes we identified have previously been described, including targeted funding for annual medicines review, computer prompts and alerts, improving information flows between multiple prescribers, improving access to expert advice and user-friendly decision support, increasing availability of non-pharmaceutical alternatives, enhancing patient engagement in medicines management, and more research, education, and training to reduce the uncertainty in practice. [21][22][23][24][25][26][27][28][29][30] The novel contribution of our research lies in its focus on everyday primary care practice, where most ongoing prescribing occurs, and on the sociocultural influences at play-the importance to physicians of maintaining relationships with both patients and colleagues. Study findings draw attention to the need for a change in culture and in the attitudes and behaviors of both patients and physicians as well as a need to "warm the patient up" to the idea of deprescribing; to the possibility that less may be better.…”

Section: Discussionmentioning

confidence: 99%

“…Most research has focused on deprescribing in residential care settings, complex case examples, and understanding the views of patients. [21][22][23][24][25][26][27][28][29][30][31] We sought to explore the views of primary care physicians on the barriers to and facilitators of deprescribing in everyday practice to inform the development of an intervention to support safer prescribing.…”

Section: Introductionmentioning

confidence: 99%

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Swimming Against the Tide: Primary Care Physicians’ Views on Deprescribing in Everyday Practice

2017

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PURPOSE Avoidable hospitalizations due to adverse drug events and high-risk prescribing are common in older people. Primary care physicians prescribe most on-going medicines. Deprescribing has long been essential to best prescribing practice. We sought to explore the views of primary care physicians on the barriers and facilitators to deprescribing in everyday practice to inform the development of an intervention to support safer prescribing. METHODSWe used a snowball sampling technique to identify potential participants. Physicians were selected on the basis of years in practice, employment status, and practice setting, with an additional focus on information-rich participants. Twenty-four semistructured interviews were audio-recorded, transcribed verbatim, and analyzed to identify emergent themes. RESULTSPhysicians described deprescribing as "swimming against the tide" of patient expectations, the medical culture of prescribing, and organizational constraints. They said deprescribing came with inherent risks for both themselves and patients and conveyed a sense of vulnerability in practice. The only incentive to deprescribing they identified was the duty to do what was right for the patient. Physicians recommended organizational changes to support safer prescribing, including targeted funding for annual medicines review, computer prompts, improved information flows between prescribers, improved access to expert advice and user-friendly decision support, increased availability of non-pharmaceutical therapies, and enhanced patient engagement in medicines management. CONCLUSIONSInterventions to support safer prescribing in everyday practice should consider the sociocultural, personal, relational, and organizational constraints on deprescribing. Regulations and policies should be designed to support physicians in practicing according to their professional ethical values.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Swimming Against the Tide: Primary Care Physicians’ Views on Deprescribing in Everyday Practice

2017

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“…GPs reported that their decision to stop unnecessary medication was influenced by their perception that specialists would disapprove of them stopping medications. A study in New Zealand investigated GPs' views on deprescribing in multimorbid elderly patients 63. Considerable variation in opinions on deprescribing was observed between GPs, and the authors proposed better guidelines for stopping medicines in order to reduce such variation.…”

Section: Barriers and Facilitators To Deprescribingmentioning

confidence: 99%

Deprescribing: a primary care perspective

2016

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Polypharmacy is an increasing and global issue affecting primary care. Although sometimes appropriate, polypharmacy can also be problematic, leading to a range of adverse consequences. Deprescribing is the process of supervised withdrawal of an inappropriate medication and has the potential to reduce some of the problems associated with polypharmacy. It is a complex and sensitive process. We examine the issue of deprescribing from the perspective of primary care. Key steps in the deprescribing process are a review of medications and corresponding indications, consideration of harms, assessment of eligibility for discontinuation, prioritisation of medications and implementation of a stopping plan with appropriate monitoring. Patient involvement is a key feature of this process. Deprescribing should be considered in the context of end-of-life care and medication safety, but approaches are also required to identify other situations where deprescribing is appropriate. General practitioners are well positioned to facilitate deprescribing, usually through formal medication review, with decisions informed by a range of other healthcare professionals. Guidelines are available that help guide these processes. A range of studies have explored attitudes towards deprescribing; patients are generally supportive of the concept, although clinician views are varied. The successful implementation of deprescribing strategies still requires important patient and clinician barriers to be overcome, and clinical trial evidence of effectiveness and safety is essential.

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“…Another study by Linsky et al identified four factors which include medication knowledge, concerns and importance as well as interest in stopping medication 7. New Zealand general practitioners were included in a study8 which explored their insight into deprescribing for the multimorbid older adult using semi-structured interviews and a hypothetical patient case. This work revealed a lack of clarity around deprescribing.…”

mentioning

confidence: 99%