Faculty of Pharmacy and Biochemistry, University of Zagreb, A. Kovačića 1, 10 000 Zagreb, Croatia.
City Pharmacies Zagreb, Kralja Držislava 6, 10 000 Zagreb, Croatia.
Int J Environ Res Public Health. 2023 Mar 11;20(6):4957. doi: 10.3390/ijerph20064957.
Deprescribing is a notable approach to improve medication management, but few healthcare systems recognize it. To introduce a new practice, it is important to examine the factors influencing the provision of a new or elaborate cognitive service within the desired setting. This study explores the perceived barriers and facilitators of deprescribing by primary healthcare providers, and identifies the factors associated with a willingness to suggest deprescribing. A cross-sectional survey was conducted (in Croatia, between October 2021 and January 2022) using a validated comprehensive healthcare providers' opinions, preferences, and attitudes towards deprescribing (CHOPPED) questionnaire. A total of 419 pharmacists and 124 physicians participated. Participants showed a high willingness to deprescribe, with significantly higher scores in physicians than in pharmacists (5.00 (interquartile range-IQR 5-5) vs. 4.00 (IQR 4-5), < 0.001). Pharmacists had significantly higher scores in seven out of ten factors (knowledge, awareness, collaboration facilitators, competencies facilitators, healthcare system facilitators, collaboration barriers, competencies barriers) while in the remaining three factors (patient facilitators, patient and healthcare system barriers) there was no difference in scores. The strongest positive correlation with willingness to suggest deprescribing was found with the collaboration and healthcare system facilitators factors for pharmacists (G = 0.331, < 0.001, and G = 0.309, < 0.001, respectively), and with knowledge, awareness, and patient facilitators factors for physicians (G = 0.446, = 0.001; G = 0.771, < 0.001; and G = 0.259, = 0.043, respectively). Primary healthcare providers are willing to suggest deprescribing but face different barriers and facilitators. For pharmacists, the most important facilitators were extrinsic, while for physicians they were more intrinsic and patient related. The stated results provide target areas which one could focus upon to help to engage healthcare providers in deprescribing.
减药是改善药物管理的一种重要方法，但很少有医疗保健系统认识到这一点。要引入一种新的实践，重要的是要研究在既定环境中提供新的或精细的认知服务的影响因素。本研究探讨了初级保健提供者对减药的认知障碍和促进因素，并确定了与愿意建议减药相关的因素。这项横断面调查（在克罗地亚，2021 年 10 月至 2022 年 1 月期间进行）使用了经过验证的全面医疗保健提供者对减药的意见、偏好和态度（CHOPPED）问卷。共有 419 名药剂师和 124 名医生参与了这项研究。参与者表示愿意减药，医生的得分明显高于药剂师（5.00（四分位距 IQR 5-5）比 4.00（IQR 4-5），<0.001）。药剂师在十个因素中的七个因素上的得分明显较高（知识、意识、协作促进因素、能力促进因素、医疗保健系统促进因素、协作障碍、能力障碍），而在另外三个因素（患者促进因素、患者和医疗保健系统障碍）上，得分没有差异。与建议减药意愿呈最强正相关的是药剂师的协作和医疗保健系统促进因素（G = 0.331，<0.001，和 G = 0.309，<0.001），以及医生的知识、意识和患者促进因素（G = 0.446，= 0.001；G = 0.771，<0.001；和 G = 0.259，= 0.043）。初级保健提供者愿意建议减药，但面临着不同的障碍和促进因素。对于药剂师来说，最重要的促进因素是外在的，而对于医生来说，促进因素则更多地与内在因素和患者相关。这些结果为我们提供了目标领域，可以关注这些领域来帮助医疗保健提供者参与减药。
