General Practitioners’ Perspectives and Barriers to Deprescribing Inappropriate Medications in Primary Care

Abstract

Introduction and objective: Potentially inappropriate prescribing (PIP) is associated with adverse drug reactions and negative outcomes in older adults. The objective of the study was to assess the reasons expressed by General Practitioner’s (GPs) to maintain their patients' PIP or the barriers to deprescribe. Material and Methods: a mixed quantitative-qualitative study to explore the GPs’ decisions and perspectives about reviewing PIP that were notified to GPs by an alert system (AS-PIP). The AS-PIP allowed GPs to send feedback information about the barriers for treatment modification, deprescribing or circumstances that were considered when taking the decision about not make any change in the medication schedule. Five types of PIP were selected. Patient reports with PIP were sent to GPs in two phases (April/2016 and July/2016). Theoretical Domains Framework was employed to classify GPs’ opinions and barriers on maintaining PIP. GPs’ feedback frequency, total and according to type of medication with PIP, and frequency distribution among main reasons recorded by GPs justifying their decision after reviewing PIP were calculated. Percentage reductions for each PIP were also evaluated. Results: The main reasons given by GPs to explain why they continued to prescribe potentially inappropriate medication were: another physician originally issued the prescription; patients had good or bad control of their illness; and the treatment was not a potential risk to the patient. The most significant views were coded into 5 domains: (i) knowledge, (ii) social/professional role and identity,(iii) beliefs about capabilities, (iv) memory, attention and decision processes, and (v) social influences. Conclusions: The study highlights the reasons given by GPs for maintaining PIP. The process of deprescribing seems to lace with many challenges for GPs. The most relevant views are associated with no update in therapeutic knowledge, social pressure or influences, and lack of professional leadership