The Barriers to Deprescription in Older Patients: A Survey of Spanish Clinicians

Abstract

Background and objective: There are barriers to deprescription that hinder its implementation in clinical practice. The objective of this study was to analyse the main barriers and limitations of the deprescription process perceived by physicians who care for multipathological patients. Materials and methods: The “deprescription questionnaire of elderly patients” was adapted to an online format and sent to physicians in geriatrics. Question 1 is a reference to establish agreement or disagreement with this practice. The influence of different aspects of deprescription was analysed via the demographic characteristics of the clinicians and perceptions of the various barriers (questions 2–9) by means of bivariate analysis. Based on the latter, a multivariate model was carried out to demonstrate the relationship between barriers and the degree of deprescription agreement among respondents. Results: Of the 72 respondents, 72.2% were in favour of deprescribing. Regarding the analyses, the demographic characteristics did not influence rankings. The deprescription of preventive drugs and consensus with patients were associated with a positive attitude towards deprescribing, while withdrawing drugs prescribed by other professionals, time constraints and patient reluctance emerged as possible barriers. The only factor independently associated with deprescribing was lack of time. Conclusions: Time was found to be the main barrier to deprescription. Training, the creation of multidisciplinary teams and integrated health systems are key facilitators.

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

“…Multimorbidity leads to the concurrent use of multiple medications [13] and the use of five or more drugs at the same time in the same patient is referred to as polypharmacy [14]. Although polypharmacy involves justifications for the use of each of the prescribed drugs, often the benefit-risk ratio becomes suboptimal in the patient when they are using them with other prescription or over-the-counter drugs [14].…”

“…Multimorbidity leads to the concurrent use of multiple medications [13] and the use of five or more drugs at the same time in the same patient is referred to as polypharmacy [14]. Although polypharmacy involves justifications for the use of each of the prescribed drugs, often the benefit-risk ratio becomes suboptimal in the patient when they are using them with other prescription or over-the-counter drugs [14]. These situations are often referred to as potentially inappropriate medication (PiM) [15], and are most often identified in case of central nervous system and psychotropic drugs (66% of evaluated patients) [16].…”

“…Although as many as 72% of physicians are in favor of deprescribing, it is difficult to introduce this into everyday practice, especially in geriatric medicine [14]. it is easier to achieve when it is pertains to preventive drugs, where the decisions can be made as part of a team with other doctors, and where the patient is also in favor of deprescribing.…”

“…it is easier to achieve when it is pertains to preventive drugs, where the decisions can be made as part of a team with other doctors, and where the patient is also in favor of deprescribing. individual physicians may be reluctant to engage with other physicians' prescriptions or when the time for changes is limited [14]. while physicians commonly accept adverse effects of drugs in patients, they are unlikely to engage in deprescribing for fear that adverse effects related to drug withdrawal might arise [81].…”