Attitudes and confidence toward deprescribing: a survey among Italian general practitioners

General practitioners (GPs) should regularly review patients' medications and, when they are potentially harmful or no longer necessary, implement deprescribing approach. We aimed to assess the perceptions and potential barriers to deprescribing among Italian GPs.

GPs were invited to participate in an observational cross-sectional study through an online survey containing 20 questions addressing attitudes towards deprescribing, including physicians' perceptions, potential barriers, and how this process is addressed in daily clinical practice. The survey, accessible for responses from 4th May 2023 to 15th January 2024, was distributed through social media, networks, medical associations, and involving primary care departments of local health authorities.

Over 8 months, 617 answers were collected. Less than 2% (n = 11) reported to not implement deprescribing interventions in daily practice, primarily due to perceived insufficient experience (n = 7) or lack of specific education (n = 6). Conversely, 23.1%(n = 142) of respondents reported frequently or very frequently implementing deprescribing. Among barriers, GPs reported difficulties in dealing with specialists (n = 438, 71.7%), distrust of patients in drug discontinuation (n = 326, 53.4%), poor availability of deprescribing guidelines (n = 231, 37.8%), and time constraints (n = 213, 34.9%). Guidelines and targeted training were mostly demanded (by 66.1% and 59.6%, respectively). Regarding specific drug classes, the proportion of GPs reporting to frequently implement deprescribing for proton pump inhibitors was 51.8% (n = 313), while percentage was lower for benzodiazepines (n = 166, 27.4%), bisphosphonates (n = 147, 24.3%), statins (n = 128, 21.2%), antihypertensives (n = 108, 17.9%), and antidepressants (n = 96, 15.9%).

The study shows that while GPs recognize the importance of deprescribing, however, they face significant barriers, including a lack in targeted education and specific guidelines to enhance their confidence and knowledge in implementing this process effectively in daily clinical practice.