Knowledge and willingness of physicians about deprescribing among older patients: a qualitative study

Abstract

PurposeThis study aimed to explore the physician’s knowledge and identify the perceived barriers that prevent family medicine physicians from engaging in deprescribing among older patients.MethodsThis qualitative study was designed and conducted using an interpretive theoretical approach. Purposive sampling was undertaken, whereby family medicine physicians of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, were invited to participate in the study. The topic guidelines were designed to give the physicians the freedom to express their views on exploring their knowledge about deprescribing and to identify the perceived barriers and enablers that prevent them from engaging in the practice in older patients. The focus group discussions were conducted in English, audio-taped with permission, and transcribed verbatim. Each transcript was independently reviewed and coded separately to explore the themes and sub-themes.ResultsA total of 15 physicians participated in three focus group discussions. Their thematic content analysis identified 24 factors that facilitated or hindered deprescribing. The facilitators included cost-effectiveness and time effectiveness, side effects avoidance, clinical pharmacist’s role, need for system(s) to help in applying deprescribing, and patient counseling/education. Similarly, barriers included lack of knowing the deprescribing term and process, patient comorbidities, risk/fear of conflict between physicians and clinical pharmacists, lack of documentation and communication, lack of time or crowded clinics, and patient resistance/acceptance.ConclusionThe study identified several factors affecting family medicine physician’s deprescribing behavior. The use of theoretical underpinning design helped to provide a comprehensive range of factors that can be directed when defining targets for intervention(s).

Low-Dose Aspirin Use Among African American Older Adults

“…This is supported by several studies that cite barriers to deprescribing as patient resistance or unwillingness to stop a medication. [49][50][51][52][53][54] Overall, our data are representative of a subpopulation of aspirin use behavior and show that use of self-or clinician-prescribed low-dose aspirin among underserved African-American older adults might be inconsistent with the recently published ACC/AHA guidelines on CVD prevention. 20 This is supported by other studies, which similarly suggested that aspirin use in the United States is widespread among groups at risk for harm.…”

Deprescribing practice in a resource‐limited setting: Healthcare providers’ insights

“…Such reluctance could be due to the fact that deprescribing is a relatively new concept in Ethiopia and thus can partially be addressed by providing continuous education and awareness programmes, developing a facilitating guideline and facilitating interdisciplinary collaborations. 30 Several studies have been conducted to understand barriers impacting HCPs' ability to deprescribe, 23,[29][30][31][32][33][34][35] which can broadly be classified into intrinsic factors (beliefs, attitudes, knowledge, skills and behaviour) and extrinsic factors (patient, work setting, healthcare system and culture). 23,32 While both clinical pharmacists and nurse have roles in direct patient care and mediation review to recommend and make decisions on drug therapy, only physicians can prescribe in Ethiopian healthcare system.…”

General Practitioners' Propensity to Cooperate With Other Health Professionals in the Management of Patients With Multimorbidity and Polypharmacy: A Cross-sectional Study.

“…Qualitative studies have indicated that some GPs fear con icts with other physicians or pharmacists when they initiate deprescription [15,31]. One hypothesis is that GPs who cooperate intensively discuss and share the responsibility for the prescription management with other professionals and might thus feel themselves supported and con dent when deprescribing.…”