National Poison Centre, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia.
School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia.
Int J Clin Pharm. 2022 Feb;44(1):201-213. doi: 10.1007/s11096-021-01336-w. Epub 2021 Oct 12.
Background Increased harmful effects of medication resulting from polypharmacy, especially among older patients, is a significant concern globally. Hence, continuous medication review and withdrawal of inappropriate medications are essential to improve patient safety. Objective To explore physicians' perceived barriers and enablers of deprescribing among older patients in the public primary healthcare setting. Setting Public primary care clinics in the northern states of Malaysia. Methods A semi-structured, face-to-face interview was conducted among physicians working in eight primary care clinics in northern Malaysia using a purposive sampling approach. Interviews were conducted using validated topic guides. All the responses were recorded, transcribed verbatim, validated, and analysed for the emerging themes using thematic analysis. Main outcome measure Physicians perceived barriers and enablers of deprescribing among geriatric patients. Results A total of eleven physicians were interviewed. Seven emerging themes were identified, which are categorised under barriers and enablers of deprescribing. The barriers were patient-specific, prescriber-specific, and healthcare provision and system. Prescriber deprescribing competencies, medication-specific outcomes, availability of empirical evidence, and pharmacist's role were the enablers identified. Conclusion Patient-specific barriers were identified as a significant challenge for deprescribing. Improving competencies on deprescribing was the repeatedly adduced enabler by physicians. The development of targeted educational training can help to reduce the obstacles faced by prescribers.
背景 由于多种药物治疗（尤其是在老年患者中）导致的药物不良影响增加，这是一个在全球范围内令人严重关切的问题。因此，持续审查药物并停用不适当的药物对于提高患者安全性至关重要。目的 探讨在马来西亚北部公立初级保健环境中，医生对老年患者减少药物治疗的认知障碍和促进因素。地点 马来西亚北部的公立初级保健诊所。方法 采用目的抽样法，对在马来西亚北部 8 家初级保健诊所工作的医生进行了半结构化的面对面访谈。访谈采用经过验证的主题指南进行。对所有的回答进行记录、逐字转录、验证，并使用主题分析对新出现的主题进行分析。主要结果 医生对老年患者减少药物治疗的认知障碍和促进因素。结果 共对 11 名医生进行了访谈。确定了七个新兴主题，这些主题分为减少药物治疗的障碍和促进因素。障碍包括患者特定、医生特定以及医疗保健提供和系统。确定的促进因素包括医生的减少药物治疗能力、药物特定的结果、实证证据的可用性以及药剂师的作用。结论 患者特定的障碍被认为是减少药物治疗的重大挑战。提高减少药物治疗的能力是医生反复提出的促进因素。有针对性的教育培训的发展可以帮助减少医生面临的障碍。
