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Interventions identified that support safer prescribing

Interventions to support safer prescribing in everyday practice should account for the organizational, personal, relational, and sociocultural constraints on the tapering and withdrawing of medicines, also known as deprescribing, according to a new study.

The research, published in Annals of Family Medicine, also suggested that any regulations and policies should champion physicians in practicing according to their professional ethical values.

“The most effective, cost-effective, and practical approach to safer prescribing in everyday practice is not yet known. Interventions that have been tried include audit and feedback, education and training, decision support, pharmacist medicines review, and enhancing patient engagement,” Katharine A. Wallis, MBChB, PhD, MBHL, department of general practice and primary health care, University of Auckland, New Zealand, and colleagues wrote. “Physician input is key to the development of successful interventions. To date, however, there has been relatively little research investigating the views of primary care physicians on deprescribing in everyday practice. Most research has focused on deprescribing in residential care settings, complex case examples, and understanding the views of patients.”

Polypharmacy is of particular concern in the geriatric population. A previous study reported that an estimated 20% of adult patients are treated with polypharmacy (five or more drugs). These researchers also found that the prevalence of this phenomenon in the elderly is even higher, ranging from 30% to 70%, even reaching 90% in residents of residential aged care facilities.

For the current study, researchers conducted interviews with 24 primary care physicians in New Zealand, querying them on how everyday experiences guided their understanding and views of polypharmacy and deprescribing in older people. Questions were based on available literature and refined for clarity as more interviews took place.

Wallis and colleagues found that physicians believed prescribing was an “easy option” but deprescribing was time-consuming. They also had fears that patients would think they were “giving up” on treating them, that their reputations would be damaged if a patient suffered adverse events, or that patients would think they were trying to save money. There were also organizational barriers such as the competing demands and fast pace of the practice. The only incentive to deprescribing they identified was the duty to do what was right for the patient.

According to researchers, the physicians had several recommendations to support safer prescribing, including organizational changes, earmarking funding for annual medicines review; computer prompts; improved information flows between prescribers and access to expert advice and user-friendly decision support; increased availability of nonpharmaceutical therapies, and enhanced patient engagement in medicines management.

“The novel contribution of our research lies in its focus on everyday primary care practice, where most ongoing prescribing occurs, and on the sociocultural influences at play — the importance to physicians of maintaining relationships with both patients and colleagues,” Wallis and colleagues wrote. “It would be logical to design regulations and policies that support physicians in practicing according to their professional ethical values — taking on the risks inherent in deprescribing and doing what was right for the patient, regardless.” – by Janel Miller

Reference : Machado-Alba JE, et al. Expert Opin Drug Saf. 2017;doi:10.1080/14740338.2017.1273347.

Disclosure: The researchers report no relevant financial disclosures.