School of Health and Life Sciences, University of Bradford, Bradford, West Yorkshire, UK
Yorkshire & Humber Patient Safety Translational Research Centre, NIHR, Bradford, England.
BMJ Open. 2022 Mar 28;12(3):e054279. doi: 10.1136/bmjopen-2021-054279.
To explore the barriers/facilitators to deprescribing in primary care in England from the perspectives of clinicians, patients living with frailty who reside at home, and their informal carers, drawing on the Theoretical Domains Framework to identify behavioural components associated with barriers/facilitators of the process.
Exploratory qualitative study.
General practice (primary care) in England.
9 patients aged 65+ living with frailty who attended a consultation to reduce or stop a medicine/s. 3 informal carers of patients living with frailty. 14 primary care clinicians including general practitioners, practice pharmacists and advanced nurse practitioners.
Qualitative semistructured interviews took place with patients living with frailty, their informal carers and clinicians. Patients (n=9) and informal carers (n=3) were interviewed two times: immediately after deprescribing and 5/6 weeks later. Clinicians (n=14) were interviewed once. In total, 38 interviews were undertaken. Framework analysis was applied to manage and analyse the data.
6 themes associated with facilitators and barriers to deprescribing were generated, respectively, with each supported by between two and three subthemes. Identified facilitators of deprescribing with patients living with frailty included shared decision-making, gradual introduction of the topic, clear communication of the topic to the patient and multidisciplinary working. Identified barriers of deprescribing included consultation constraints, patients' fear of negative consequences and inaccessible terminology and information.
This paper offers timely insight into the barriers and facilitators to deprescribing for patients living with frailty within the context of primary care in England. As deprescribing continues to grow in national and international significance, it is important that future deprescribing interventions acknowledge the current barriers and facilitators and their associated behavioural components experienced by clinicians, patients living with frailty and their informal carers to improve the safety and effectiveness of the process.
从临床医生、居住在家中患有衰弱症的患者及其非专业护理人员的角度出发，探索英格兰初级保健中减少用药的障碍/促进因素，利用理论领域框架确定与该过程障碍/促进因素相关的行为成分。
探索性定性研究。
英格兰的全科医生（初级保健）。
9 名年龄在 65 岁以上、患有衰弱症的患者，他们参加了减少或停止一种药物的咨询。3 名患有衰弱症患者的非专业护理人员。14 名初级保健临床医生，包括全科医生、执业药剂师和高级执业护师。
对患有衰弱症的患者、他们的非专业护理人员和临床医生进行定性半结构式访谈。患者（n=9）和非专业护理人员（n=3）进行了两次访谈：在减少或停止用药后立即进行，然后在 5/6 周后再次进行。临床医生（n=14）进行了一次访谈。总共进行了 38 次访谈。应用框架分析来管理和分析数据。
分别生成了与减少用药的促进因素和障碍相关的 6 个主题，每个主题都有两个到三个亚主题支持。与与患有衰弱症的患者共同减少用药的促进因素包括共同决策、逐步引入话题、向患者清楚地传达话题以及多学科合作。与减少用药的障碍包括咨询限制、患者对负面后果的恐惧以及难以理解的术语和信息。
本文及时深入地探讨了英格兰初级保健中患有衰弱症的患者减少用药的障碍和促进因素。随着减少用药在国内外的重要性不断增加，未来的减少用药干预措施需要承认当前的障碍和促进因素及其相关行为成分，这些是临床医生、患有衰弱症的患者及其非专业护理人员所经历的，以提高该过程的安全性和有效性。
