Laboratory of Quality Assessment of Geriatric Therapies and Services, Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156 Milan, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Milan, 20122 Italy.
Maturitas. 2020 Apr;134:29-33. doi: 10.1016/j.maturitas.2020.01.009. Epub 2020 Jan 25.
Even though increasing attention is given to deprescribing owing to the risks related to polypharmacy in older adults, deprescribing is not yet part of clinical culture.
We conducted three focus groups with 25 internists, geriatricians and general practitioners to explore the factors influencing the implementation of deprescribing in the Italian context, and more specifically: i. to investigate the barriers to deprescribing; ii. to define strategies and actions to address these barriers; and iii. to identify skills and tools that may assist in implementing deprescribing in clinical practice. Thematic analysis was used.
Six themes were identified: Good reasons for deprescribing, Difficulties and doubts about deprescribing, System factors affecting polypharmacy and deprescribing, Perspectives on how to practically approach polypharmacy, Need for effective communication with patients and caregivers, Taking responsibility and starting action. Participants reported a willingness to challenge themselves by addressing the barriers to deprescribing through regular review of prescriptions and collaboration with colleagues and patients.
Italian internists, geriatricians and general practitioners reported many system-level barriers to deprescribing as well as some doubts about its necessity. Strategies to address the barriers to deprescribing include regular medication review and enhancing collaboration with colleagues and patients. Additionally, participants were willing to challenge themselves and use uncertainty as an impetus for deprescribing.
尽管由于老年人多种药物治疗相关的风险，人们越来越关注减少用药，但减少用药尚未成为临床文化的一部分。
我们进行了三次焦点小组讨论，共有 25 名内科医生、老年病学家和全科医生参加，旨在探讨影响意大利减少用药实施的因素，具体包括：i. 调查减少用药的障碍；ii. 确定解决这些障碍的策略和行动；iii. 确定可能有助于在临床实践中实施减少用药的技能和工具。采用主题分析方法。
确定了六个主题：减少用药的充分理由、减少用药的困难和疑虑、影响多种药物治疗和减少用药的系统因素、实际处理多种药物治疗的方法、与患者和护理人员进行有效沟通的必要性、承担责任和采取行动。参与者表示愿意通过定期审查处方以及与同事和患者合作来解决减少用药的障碍，从而挑战自我。
意大利内科医生、老年病学家和全科医生报告了许多减少用药的系统障碍，以及对其必要性的一些疑虑。解决减少用药障碍的策略包括定期进行药物审查，并加强与同事和患者的合作。此外，参与者愿意挑战自我，并将不确定性作为减少用药的动力。
