Alharthi Mohammed S
Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia.
Healthcare (Basel). 2025 May 28;13(11):1274. doi: 10.3390/healthcare13111274.
Polypharmacy, commonly defined as the use of five or more medications, is a growing concern in hospitals due to its association with adverse drug reactions, functional decline, and increased healthcare costs. Proactive deprescribing, which involves the planned discontinuation of unnecessary or potentially harmful medications, can optimise medication use. However, multiple barriers hinder its implementation. Saudi Arabia offers a unique context for deprescribing due to strong family roles in care, prevalent prescribing norms, and ongoing shifts toward value-based healthcare. This study explores the barriers and facilitators to proactive deprescribing among physicians in Saudi hospitals using the Theoretical Domains Framework (TDF). The TDF was used as it effectively identifies behavioural factors influencing clinical decision making in practice.
Semi-structured interviews were conducted with 27 purposively sampled physicians experienced in managing polypharmacy. The interviews were transcribed and analysed thematically, with behavioural determinants identified and categorised according to the 14 domains of the Theory of Planned Behaviour (TDF).
Enablers included the availability of deprescribing guidelines, decision-support tools, interprofessional collaboration, and institutional backing. Physicians with specialised training expressed greater confidence in conducting deprescribing. Identified barriers included limited time, heavy workload, absence of standardised protocols, medico-legal concerns, resistance from patients and caregivers, and lack of formal training. These factors were categorised under seven key TDF domains, with Environmental Context and Resources, Social Influences, and Beliefs About Capabilities identified as the most influential in shaping physicians' deprescribing practices. Interactions between factors were observed, where supportive environments and collaborative teams helped offset key barriers such as time constraints, legal concerns, and patient resistance.
This study identified key behavioural and contextual factors influencing proactive deprescribing in Saudi hospital settings. Addressing barriers such as heavy workload, medico-legal concerns, and lack of standardised protocols through targeted interventions, including clinician training, institutional support, and multidisciplinary collaboration, may facilitate the integration of deprescribing into routine practice. The findings offer context-specific insights to inform future efforts aimed at improving medication safety and optimising prescribing in the Saudi healthcare system.
多重用药通常被定义为使用五种或更多药物，由于其与药物不良反应、功能衰退及医疗成本增加相关，在医院中日益受到关注。主动减药，即有计划地停用不必要或有潜在危害的药物，可优化药物使用。然而，多种障碍阻碍了其实施。由于家庭在护理中的重要作用、普遍的处方规范以及向基于价值的医疗保健的持续转变，沙特阿拉伯为减药提供了独特的背景。本研究使用理论域框架（TDF）探讨沙特医院医生主动减药的障碍和促进因素。使用TDF是因为它能有效识别影响临床实践中决策的行为因素。
对27名有多重用药管理经验的医生进行了目的抽样的半结构化访谈。访谈内容被转录并进行主题分析，行为决定因素根据计划行为理论（TDF）的14个领域进行识别和分类。
促进因素包括减药指南的可用性、决策支持工具、跨专业协作和机构支持。接受过专门培训的医生在进行减药时表现出更大的信心。已识别的障碍包括时间有限、工作量大、缺乏标准化方案、医疗法律问题、患者和护理人员的抵触以及缺乏正规培训。这些因素被归类在TDF的七个关键领域下，其中环境背景与资源、社会影响以及对能力的信念被确定为对医生减药实践影响最大的因素。观察到了因素之间的相互作用，即支持性环境和协作团队有助于抵消诸如时间限制、法律问题和患者抵触等关键障碍。
本研究确定了影响沙特医院环境中主动减药的关键行为和背景因素。通过有针对性的干预措施，包括临床医生培训、机构支持和多学科协作，解决诸如工作量大、医疗法律问题和缺乏标准化方案等障碍，可能有助于将减药纳入常规实践。研究结果提供了针对具体情况的见解，为未来旨在提高沙特医疗系统中药物安全性和优化处方的努力提供参考。
