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Patient, carer and healthcare professional perspectives on deprescribing in surgical wards: A mixed methods study
Bonnie M Liu1,2, Janani Thillainadesan3,4, Aili Langford5,6
1Ageing and Pharmacology Laboratory, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, Australia.
Aims:
The perspectives of patients and healthcare professionals regarding deprescribing in surgical wards within hospital settings are unknown. The aim of this study was to explore current practices, attitudes and the enablers and barriers to deprescribing in hospital for older surgical inpatients from the perspectives of doctors, pharmacists, patients and carers.
Methods:
A mixed methods study was performed. Two surveys were administered Australia-wide (revised Patients' Attitudes Towards Deprescribing questionnaire for patients/carers and Deprescribing Self-Efficacy Survey for doctors/pharmacists). Interviews, focus groups and observations of ward rounds were conducted with participants from five Australian hospitals. Quantitative data were analysed descriptively, while qualitative data were examined using a combined inductive and deductive approach, with results triangulated.
Results:
There were 109 survey participants (58 doctors/pharmacists and 51 patients/carers), 28 interview/focus group participants (15 doctors/pharmacists and 13 patients/carers) and eight ward round participants. Doctors and pharmacists reported low to moderate levels of confidence in deprescribing. While most patients and carers were satisfied with their medications, they expressed a willingness to consider deprescribing. Five themes were identified from the interviews, focus groups and ward round observations: (1) deprescribing is not a priority, (2) medication review occurs in response to triggers, (3) knowledge about deprescribing is limited, (4) deprescribing requires a team effort and (5) trust, rapport and communication are essential for successful deprescribing.
Conclusions:
Doctors working on surgical wards are unlikely to proactively deprescribe medications. A collaborative patient-centred approach involving geriatricians, clinical pharmacologists and pharmacists, along with educational interventions may facilitate deprescribing for surgical patients.
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