Deprescribing in Primary Care in Singapore: Barriers and Facilitators

OBJECTIVES: To describe the prevalence of potentially inappropriate medications (PIMs) in older patients (65 years of age and older) in three selected polyclinics (PCs) and gather the perceptions of the health care providers in these PCs on the barriers and facilitators of deprescribing in their practice. To analyze the patients' age, number of active chronic diseases, and number of medicines, and investigate if they could influence the presence of PIMs. DESIGN: The study has two separate parts: The first part is a retrospective cross-sectional data collection of prescriptions; the second part is a prospective cross-sectional analysis of questionnaires by health care providers. SETTING: The study is in an institutional primary care setting. PATIENTS, PARTICIPANTS: Prescriptions were from 210 randomly selected patients 65 years of age or older with at least five long-term medications, who had attended the PCs over a selected 10-day period. Health care providers from the PCs were surveyed via an anonymous questionnaire. RESULTS: The prevalence of PIMs is 44% of the prescriptions. The most prevalent PIM is "long-term proton pump inhibitor (PPI) without documented indication" at 45.7%. The number of active chronic diseases and total number of medications are associated with prevalence of PIMs. Facilitators and barriers of deprescribing highlighted are motivation and goals of the health care providers, knowledge, lack of time for deprescribing, and communication between specialists and primary care providers. CONCLUSION: PPI is a feasible drug class to start deprescribing in primary care. Knowing the barriers and facilitators would set the impetus for future work to make deprescribing more widespread and acceptable for primary care in Singapore.