Department of Clinical Pharmacy & Bio-Pharmacy, Olabisi Onabanjo University, Sagamu Campus, Nigeria.
BMC Health Serv Res. 2024 May 24;24(1):661. doi: 10.1186/s12913-024-11101-0.
Deprescribing is a clinical intervention aimed at managing polypharmacy and improving older adults' health outcomes. However, evidence suggests that healthcare professionals (HCPs) may face challenges in implementing the intervention. This study aimed to explore the considerations, barriers and enablers of deprescribing among HCPs in Southwest Nigeria.
A quantitative cross-sectional survey was carried out among consecutively sampled HCPs including physicians, pharmacists and nurses in two public tertiary healthcare hospitals in Ogun State, Southwest, Nigeria. A structured 43-item self-administered questionnaire was used to explore the participants' sociodemographics, HCPs' experience, considerations, barriers and enablers of deprescribing in older adults. The data were summarised using descriptive statistics including frequency and percentage. The Kruskal-Wallis test was used to determine differences in perceptions among the groups on a Likert scale. A p-value < 0.05 was considered significant.
Overall, 453 copies of the questionnaire were analysed. Of the participants 204 (45.0%) were within the age group of 20-30 years; 173 (38.2%) claimed that older adults occasionally requested deprescribing of their medications. The majority (417; 92.1%) considered patients' quality of life to be very important in deprescribing; 423 (93.4%) opined that having a care goal known to members of the HCP team is an enabler for deprescribing while 308 (68.0%) disagreed or strongly disagreed that lack of incentives and remuneration for HCPs that de-prescribe is a barrier to deprescribing. There is a significant difference among the participants across professional groups on the assertion that pressure from pharmaceutical companies is a barrier to deprescribing in older adults (p = 0.037).
The participants in this study had various considerations for deprescribing medication in older adults including patients' quality of life. Having a care goal known to every HCP involved in managing a patient is an enabler for deprescribing while the lack of incentives and remuneration for HCPs that de-prescribe may not necessarily be a barrier to deprescribing. There is a need for regulations and policies to support the identified enablers among HCPs and reduce the barriers to effective deprescribing process.
减少用药是一种旨在管理老年人多药治疗并改善其健康结果的临床干预措施。然而，有证据表明医疗保健专业人员（HCP）在实施该干预措施时可能面临挑战。本研究旨在探索尼日利亚西南部两家公立三级保健医院的 HCP 对减少老年人用药的考虑因素、障碍和促进因素。
在奥贡州西南部的两家公立三级保健医院，对连续抽样的 HCP（包括医生、药剂师和护士）进行了一项定量横断面调查。使用 43 项结构化的自我管理问卷，探讨了参与者对老年人减少用药的社会人口统计学、HCP 经验、考虑因素、障碍和促进因素的看法。使用描述性统计数据（包括频率和百分比）总结数据。使用 Kruskal-Wallis 检验在 Likert 量表上确定了不同群体之间的感知差异。p 值<0.05 被认为具有统计学意义。
总体而言，分析了 453 份问卷。参与者中，204 人（45.0%）年龄在 20-30 岁之间；173 人（38.2%）表示老年人偶尔会要求减少用药。大多数（417；92.1%）认为患者的生活质量在减少用药中非常重要；423 人（93.4%）认为知道 HCP 团队成员的护理目标是减少用药的促进因素，而 308 人（68.0%）不同意或强烈不同意缺乏 HCP 减少用药的激励和报酬是减少用药的障碍。在制药公司的压力是否是减少老年人用药的障碍这一观点上，参与者在不同专业群体之间存在显著差异（p=0.037）。
本研究中的参与者对减少老年人用药有各种考虑因素，包括患者的生活质量。每个参与管理患者的 HCP 都知道护理目标是减少用药的促进因素，而缺乏 HCP 减少用药的激励和报酬不一定是减少用药的障碍。需要制定法规和政策，以支持 HCP 确定的促进因素，并减少有效减少用药过程的障碍。
