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Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study

BACKGROUND: Deprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients’ and doctors’ perspectives regarding the deprescribing of medications in older persons, particularly from developing c...

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Autores principales: Goh, Sheron Sir Loon, Lai, Pauline Siew Mei, Ramdzan, Siti Nurkamilla, Tan, Kit Mun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10311750/
https://www.ncbi.nlm.nih.gov/pubmed/37391698
http://dx.doi.org/10.1186/s12875-023-02084-8
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author Goh, Sheron Sir Loon
Lai, Pauline Siew Mei
Ramdzan, Siti Nurkamilla
Tan, Kit Mun
author_facet Goh, Sheron Sir Loon
Lai, Pauline Siew Mei
Ramdzan, Siti Nurkamilla
Tan, Kit Mun
author_sort Goh, Sheron Sir Loon
collection PubMed
description BACKGROUND: Deprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients’ and doctors’ perspectives regarding the deprescribing of medications in older persons, particularly from developing countries. This study aimed to explore the necessities and concerns of deprescribing in older persons among older ambulatory patients and primary care trainees. METHODS: A qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data. RESULTS: Twenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges. CONCLUSION: Deprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they ‘didn’t want to rock the boat’. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-023-02084-8.
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spelling pubmed-103117502023-07-01 Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study Goh, Sheron Sir Loon Lai, Pauline Siew Mei Ramdzan, Siti Nurkamilla Tan, Kit Mun BMC Prim Care Research BACKGROUND: Deprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients’ and doctors’ perspectives regarding the deprescribing of medications in older persons, particularly from developing countries. This study aimed to explore the necessities and concerns of deprescribing in older persons among older ambulatory patients and primary care trainees. METHODS: A qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data. RESULTS: Twenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges. CONCLUSION: Deprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they ‘didn’t want to rock the boat’. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-023-02084-8. BioMed Central 2023-06-30 /pmc/articles/PMC10311750/ /pubmed/37391698 http://dx.doi.org/10.1186/s12875-023-02084-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Goh, Sheron Sir Loon
Lai, Pauline Siew Mei
Ramdzan, Siti Nurkamilla
Tan, Kit Mun
Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study
title Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study
title_full Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study
title_fullStr Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study
title_full_unstemmed Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study
title_short Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study
title_sort weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10311750/
https://www.ncbi.nlm.nih.gov/pubmed/37391698
http://dx.doi.org/10.1186/s12875-023-02084-8
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