Barriers to appropriate prescribing in older adults with multimorbidity: A modified Delphi study.

Wendy Ang,Jia Ying Tang,Jia Qi Lee,Yew Yoong Ding,Keng Teng Tan,Penny Lun

doi:10.1002/agm2.12169

Abstract

ObjectivesWe aimed to understand the barriers experienced by physicians when prescribing for older adults with multimorbidity in specialist outpatient clinics in Singapore.MethodsA modified Delphi study was conducted via email with 20 panel experts in the field of geriatric medicine. Barriers identified from an earlier scoping review were presented as statements to the panel.ResultsEleven barrier statements reached consensus with high importance according to the Delphi panel. Of these statements, seven (64%) belong to the domain of Environmental context and resources in the Theoretical Domains Framework (TDF), while the remaining barriers belong to the domains of skills, knowledge, intentions, and professional/social role and identity. The barriers are further linked to intervention functions in the Behaviour Change Wheel (BCW).ConclusionLinking the TDF domains to intervention functions revealed strategic directions for the development of an intervention to address the barriers and optimize prescribing.

Highlights

Inappropriate prescribing (PIP) in older adults is a rising concern around the world, as life expectancies are increasing and people are living longer with multimorbidity.[1]
A systematic review on the prevalence of potentially inappropriate medication use in older inpatients with or without cognitive impairment found the range to be from 0.6% to 88.5% when using clinical tools such as Beers criteria and Screening Tool of Older Persons’ Prescriptions (STOPP).[4]
We demonstrated that it is possible to link barriers experienced by physicians to intervention functions via the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) framework

Summary

Introduction

Inappropriate prescribing (PIP) in older adults is a rising concern around the world, as life expectancies are increasing and people are living longer with multimorbidity.[1]. With trends in polypharmacy and PIP expected to continue rising among older adults,[1,5] it is crucial to

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