Internists' deprescribing behavior for proton pump inhibitor therapy: a qualitative study based on the theoretical...

Proton pump inhibitors (PPIs) are among the most frequently prescribed medications. However, they are often used inappropriately and may cause adverse effects in long-term use. This study aimed to explore internists' beliefs, attitudes and behaviors regarding deprescribing PPIs in Türkiye, by using the Theoretical Domains Framework (TDF).

This qualitative study was conducted at a university hospital in Türkiye. Data were collected through face-to-face, in-depth interviews conducted in March-April 2023. The participants were selected through convenience sampling from among the residents and specialists working in the internal medicine department. A semi-structured interview guide, including two vignettes, was used. The data were evaluated using thematic analysis in Atlas.ti program.

A total of 12 participants (10 residents and two specialists) participated in the study. Internists' behaviors related to deprescribing were mapped to 12 TDF domains including barriers (environmental context and resources, reinforcement, social influences, optimism/pessimism and emotions, social/professional role and identity, and knowledge and skills, beliefs about consequences) and enablers (intention and goals, memory, attention, and decision-making processes, beliefs about consequences). Despite the challenges posed by a fragmented healthcare system, heavy workload, poor coordination among providers, and patients' strong expectations of PPIs as "rescue" drugs, the participants still expressed an intention to deprescribe.

This study highlights the need for systemic changes to improve deprescribing practices for PPIs in Türkiye. To promote deprescribing, appropriate behavior change techniques and implementation strategies should be identified and evaluated to ensure integrated care, evidence-based guidelines, and patient-centered practice.

Not Applicable.