Liu Bonnie M, Thillainadesan Janani, Langford Aili, Fujita Kenji, Gnjidic Danijela, Hilmer Sarah N
Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia.
Aged Care Department, Royal North Shore Hospital, Sydney, Australia.
Br J Clin Pharmacol. 2025 Sep;91(9):2684-2695. doi: 10.1002/bcp.70088. Epub 2025 May 12.
The perspectives of patients and healthcare professionals regarding deprescribing in surgical wards within hospital settings are unknown. The aim of this study was to explore current practices, attitudes and the enablers and barriers to deprescribing in hospital for older surgical inpatients from the perspectives of doctors, pharmacists, patients and carers.
A mixed methods study was performed. Two surveys were administered Australia-wide (revised Patients' Attitudes Towards Deprescribing questionnaire for patients/carers and Deprescribing Self-Efficacy Survey for doctors/pharmacists). Interviews, focus groups and observations of ward rounds were conducted with participants from five Australian hospitals. Quantitative data were analysed descriptively, while qualitative data were examined using a combined inductive and deductive approach, with results triangulated.
There were 109 survey participants (58 doctors/pharmacists and 51 patients/carers), 28 interview/focus group participants (15 doctors/pharmacists and 13 patients/carers) and eight ward round participants. Doctors and pharmacists reported low to moderate levels of confidence in deprescribing. While most patients and carers were satisfied with their medications, they expressed a willingness to consider deprescribing. Five themes were identified from the interviews, focus groups and ward round observations: (1) deprescribing is not a priority, (2) medication review occurs in response to triggers, (3) knowledge about deprescribing is limited, (4) deprescribing requires a team effort and (5) trust, rapport and communication are essential for successful deprescribing.
Doctors working on surgical wards are unlikely to proactively deprescribe medications. A collaborative patient-centred approach involving geriatricians, clinical pharmacologists and pharmacists, along with educational interventions may facilitate deprescribing for surgical patients.
患者及医护人员对于医院外科病房撤药的看法尚不清楚。本研究旨在从医生、药剂师、患者及护理人员的角度，探讨老年外科住院患者在医院撤药的当前做法、态度以及促成因素和障碍。
开展了一项混合方法研究。在澳大利亚全国范围内进行了两项调查（针对患者/护理人员的经修订的患者对撤药的态度问卷，以及针对医生/药剂师的撤药自我效能量表）。对来自澳大利亚五家医院的参与者进行了访谈、焦点小组讨论以及查房观察。对定量数据进行描述性分析，对定性数据采用归纳与演绎相结合的方法进行审查，并对结果进行三角互证。
共有109名调查参与者（58名医生/药剂师和51名患者/护理人员）、28名访谈/焦点小组参与者（15名医生/药剂师和13名患者/护理人员）以及8名查房参与者。医生和药剂师表示在撤药方面的信心水平较低至中等。虽然大多数患者和护理人员对其用药情况感到满意，但他们表示愿意考虑撤药。从访谈、焦点小组讨论和查房观察中确定了五个主题：（1）撤药并非优先事项，（2）药物审查是对触发因素做出的反应，（3）关于撤药的知识有限，（4）撤药需要团队合作，（5）信任、融洽关系和沟通对于成功撤药至关重要。
在外科病房工作的医生不太可能主动进行撤药。一种以患者为中心的协作方法，涉及老年病学家、临床药理学家和药剂师，以及教育干预措施，可能有助于为外科患者进行撤药。
