Doctors' perceived barriers and enablers of deprescribing among elderly patients in government health clinics in Northeast Penang Island District (NPID): A qualitative study

Abstract

Deprescribing has been identified as the most appropriate way to reduce polypharmacy. Deprescribing is the process of withdrawal of inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes. The objective of this study is to explore the doctors’ perspectives on the barriers and enablers of deprescribing among geriatrics in government health clinics of NPID. A qualitative study was undertaken using the semi-structured, face-to-face interview in 8 government health clinics in NPID. Interviews were recorded with permission and transcribed verbatim. Transcripts were read at least 3 times until themes were identified. Themes were identified with iterative building of a coding list until all data was accounted for. Interviews continued until saturation of ideas occurred. A thematic analysis was applied to identify themes related to deprescribing barriers or enablers. Interview was sought from 55 doctors, but only 15 responded. A saturation point was attained after interviewing 11 GPs. From the interview, 9 themes related to barriers, and 14 themes related to enablers of deprescribing were generated. The 9 barriers fall into 3 main categories, namely patients' factors, prescribers' factors, and health care system/processes. The 14 enablers fall 2 into 4 main categories, viz. prescriber deprescribing competencies, medication-specific outcomes, availability of empirical evidences, and pharmacist's role. Psychological barriers were the major barriers to deprescribing while prescribers’ deprescribing competencies were found to be the major enablers to deprescribing in geriatrics. Therefore, understanding the doctors’ perspectives on the barriers and enablers of deprescribing is crucial.