Barriers and enablers of elderly care specialists towards deprescribing practices in the nursing homes: a focus group study

Polypharmacy increases as patients age. It is associated with a decline in quality of life and an increased risk of potentially inappropriate medications (PIMs). These are highly prevalent among long-term care residents in European countries. The potential benefits of deprescribing, as the process of withdrawing PIM’s are widespread, including improvements in both health and quality of life for patients. An overview of the barriers and enablers of deprescribing is still lacking in national research or policy discussions involving a larger group of Elderly Care specialist (ECS), who aim to maintain or improve the quality of life of elderly and chronically ill patients in the Netherlands. In this study, we explored the barriers and enablers of deprescribing among ECSs. A focus group study was conducted with two groups comprising a total of 11 ECSs. A theme list was prepared to guide the interviews. The audio recordings were transcribed verbatim by one and verified independently by another researcher. Analysis of the reports was carried out through thematic coding using Atlas.TI, performed independently by two researchers. After each step of the coding they were compared, verified and, if necessary, adjusted after consultation. ECSs mentioned that gaining clinical experience and knowledge contributed to a positive attitude towards deprescribing. It is crucial to involve patients and their families and have support from care managers through official policy. Obstacles for deprescribing comprised lack of a medical history, the fear of the negative consequences of reducing medication, the lack of clinical guidelines regarding deprescribing, and the believe that a particular medication can be effective. The factor related to patient and family has a direct positive or negative impact on deprescribing if there is or is not cooperation. Deprescribing in nursing home residents remains a challenge. The ECSs are both positive about and aware of its importance. At the same time the collaboration between all parties, including doctor and patient/family and other disciplines such as management and pharmacists and paramedics, was mentioned as a key working method in this regard.