Prescribers' perceptions of medication discontinuation: survey instrument development and validation

Primary care providers (PCPs) and clinical pharmacists have concerns about the adverse consequences of using medications inappropriately and generally support the notion of reducing unnecessary drugs. Despite this attitude, many factors impede clinicians' ability to discontinue medication in clinical settings. We sought to develop a survey instrument that assesses PCPs' and pharmacists' experiences, attitudes, and beliefs toward medication discontinuation.

Survey development and psychometric assessment.

Based on a conceptual framework, we developed a questionnaire and surveyed a national sample of Department of Veterans Affairs PCPs with prescribing privileges, including physicians, nurse practitioners, physician assistants, and clinical pharmacy specialists. We randomly divided respondents into derivation and validation samples and used iterations of multi-trait analysis to assess the psychometric properties of the proposed measures. Multivariable regression models identified factors associated with the outcome of self-rated comfort with medication discontinuation.

Using established criteria for scale development, we identified 5 scales: Medication Characteristics, Current Patient Clinical Factors, Predictions of Future Health States, Patients' Resources to Manage Their Own Health, and Education and Experience. Three of these dimensions predicted providers' self-rated comfort with making decisions to discontinue medication (Current Patient Clinical Factors, Predictions of Future Health States, and Education and Experience).

We developed a psychometrically sound instrument to measure prescribers' attitudes toward, and experiences with, medication discontinuation. This survey will enable identification of perceived barriers to, and facilitators of, proactive discontinuation-an important step toward developing interventions that improve the quality and safety of care in medication use.