Patient, carer and healthcare professional perspectives on deprescribing
in surgical wards: A mixed methods study
Abstract
Background: The perspectives of patients and healthcare professionals
regarding deprescribing in surgical wards within hospital settings are
unknown. Objective: 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.