General Practitioners’ Perspectives and Barriers to Deprescribing Inappropriate Medications in Primary Care
Montero-Balosa MC, Caraballo-Camacho MO, Cejudo-López A, Solís De Dios JM, Molina-López MT
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.
