Survey on barriers to deprescribing

Adverse drug reactions were the most common reason cited for deprescribing a drug according to survey results published in the Journal of the American Geriatrics Society.

Over 80% of the physicians who responded reported that they had recently considered deprescribing a cardiovascular medication and the majority of geriatricians (73%) said they might deprescribe a medicine that was not expected to benefit patients who had a limited life expectancy.

The researchers aimed to learn how frequently physicians from different specialties said they deprescribed cardiovascular medications (drugs for heart conditions) in their practices. Cardiovascular medications, such as blood thinners and medications for lowering blood pressure and cholesterol, are among the most commonly prescribed medication classes. Although the benefits of these medications for reducing heart attacks and stroke are proven, these treatments also have contributed to rising rates of polypharmacy and adverse drug events in older adults.

The research team was interested in learning why different specialists deprescribed some of these medications, and what difficulties they faced when they did so. The researchers also wanted to know about the priorities different specialties considered when deprescribing. The research team surveyed 750 geriatricians, general internists, and cardiologists.

The response rate to the survey was 26% for geriatricians, 26% for general internists, and 12%for cardiologists.

Barriers to deprescribing drugs

Barriers to deprescribing were shared across specialties. One concern was about interfering with another physician’s treatment plans, since some medications may be prescribed or recommended by several different providers who don’t always work together. Another concern was patient reluctance to stop taking prescribed medications.

More geriatricians (26%) reported concerns about cognition (the ability to think and made decisions) as a reason for deprescribing, compared to 13% of general internists and nine percent of cardiologists.

The researchers concluded that their survey showed that geriatricians, general internists, and cardiologists frequently consider deprescribing cardiovascular medications. They noted that successfully implementing patient-centric deprescribing will require improved communication between all physicians and their patients.

They said: “We hope our study will contribute to advancing deprescribing as a patient-centered strategy that can improve the safety of medication prescribing practice and improve the wellbeing of older adults.”