Factors which influence the deprescribing decisions of community‐living older adults and GPs in Australia

Abstract

Deprescribing aims to reduce polypharmacy and inappropriate medication use. Both General Practitioners (GPs) and older adults have expressed a willingness to consider deprescribing. However, deprescribing is often deferred in practice. The aim of this study was to identify factors which influence GP and older adult decisions about deprescribing in primary care. Semi-structured interviews were used in this qualitative study, conducted in a regional area in Australia. Participants included GPs and adults aged 65 years or older, using five or more medications and living independently in the community. Data were collected between January 2018 and May 2019. Thematic analysis was used to analyse the verbatim transcribed interviews using NVivo 12. A total of 41 interviews were conducted, 25 with older adults and 16 with GPs. Four key themes influenced deprescribing decisions: views of ageing, shared decision-making, attitudes toward medication use and characteristics of the health care environment.Discussions of deprescribing were limited by the influence of negative stereotypes toward age and ageing, a lack of older adult participation in shared decision-making, a positive attitude towards ongoing medication use and perception of the normality of using medications in older age. Time constraints, poor communication about prescribing information and unclear roles regarding responsibility for deprescribing also prevented discussions. Continuity of care, involvement of older adults in medication reviews and GPs who asserted their generalist role were the main factors which promoted discussion of deprescribing. GPs are well placed to discuss deprescribing with their older patients because they are trusted and can provide continuity of care.Actively encouraging and involving older adults in medication reviews in order to understand their preferences, supports shared decision-making about deprescribing.Active involvement may also reduce the influence of negative views of ageing held by both older adults and GPs.

Stakeholder Perspectives on Factors Related to Deprescribing Potentially Inappropriate Medications in Older Adults Receiving Dialysis

“…Studies conducted in general older adult populations have highlighted similar issues, as well as fragmented care, patient perceptions, and clinician self-efficacy or belief in their ability to conduct the deprescribing process. [27][28][29][30] Our study builds on this literature by adding data from key stakeholders (patients, caregivers, clinicians from multiple care settings [dialysis, primary care, and pharmacist]) and using the IP-SDM model to identify system-and individual-level factors relevant to deprescribing potentially inappropriate medications.…”

Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data

“…There is a general perception that continuity of care (CoC) in general practice is linked to increased use of preventive care, 1 better medication adherence, 2 , 3 reduced polypharmacy, 4 lower utilisation of health care, 5 fewer acute hospital admissions, 6 , 7 and lower mortality. 6 , 8 , 9 Despite this, continuity is declining in many countries, 10 – 12 and structural changes in healthcare systems, prioritising quick access to any GP, and increasing GP workload are discussed as common reasons.…”

De-prescribing in primary care: the clinical, ethical and psychological considerations

“…Several studies have tried to understand the psychological aspects and belief systems effecting a patients' contribution to decision making. 18 For some, medications can serve as more than just treatment; they act as a symbol of stability in the face of age-related vulnerabilities. 19 Similarly, they can be perceived as an unavoidable accompaniment of aging, and something vital for preserving or even lengthening life (a view reinforced by medical professionals).…”