ADDRESSING INAPPROPRIATE POLYPHARMACY IN THE ELDERLY: BARRIERS AND ENABLERS TO DEPRESCRIBING IN ROUTINE DAILY PRACTICE

Introduction & objective Polypharmacy is common in the elderly. Many medications the elderly take are potentially inappropriate where the potential risks outweigh the potential benefits. Deprescribing is the process of tapering and withdrawing medications. Deprescribing is integral to best prescribing practice but doctors sometimes struggle to make deprescribing part of routine daily practice. The purpose of this study was to explore the views of general practitioners on the barriers to deprescribing in practice and to identify the factors that facilitate doctors deprescribing. Method Semi-structured interviews with doctors from around New Zealand of varying levels of experience, and working in a variety of community settings excluding residential aged care facilities. Interviews were digitally recorded, transcribed verbatim, and analysed to identify themes using the general inductive approach. Results & conclusions Most participants were aware of increasing polypharmacy in the elderly and were concerned about polypharmacy related harm. Contributory factors were identified as single disease specific guidelines, lack of guidance about what to do in multi-morbidity, and when to stop medicines; multiple prescribers and a lack of continuity of care; and marketing campaigns promoting diseases and medications to patients. Barriers to deprescribing included lack of time, funding, knowledge and confidence; patient reluctance to stop long-term medications, a poor or short-term doctor-patient relationship, reluctance to discuss limited life expectancy; and fear of blame for adverse outcomes. Facilitators to deprescribing included computer generated reminders, audits, and alerts; access to educational resources, user-friendly websites and expert pharmacists; funded time; and increasing patient awareness.