The barriers to stopping inappropriate medicines (deprescribing): A patient and supporting peer perspective
Older people with frailty are frequently prescribed multiple medicines for co-morbidities resulting in polypharmacy (the concurrent use of five or more medicines). Polypharmacy can be beneficial; however, inappropriate polypharmacy is common and can lead to adverse health outcomes, particularly in this population. The National Health Service (NHS) recognises this issue in its Long Term Plan (2019), with Primary Care Networks (PCNs) responsible for implementing structured medicine reviews to stop unnecessary or harmful medicines (deprescribing). However, little is understood from the patient’s perspective, particularly around the barriers older people with frailty face when reducing or stopping their medicines. The aim of this research was to investigate the barriers older people with frailty and their supporting peers (i.e. SPs, those who help patients manage their medicines at home) experience when stopping medicines. This is part of a wider programme of work investigating how deprescribing can be safely implemented in primary care using a behaviour change approach.
A qualitative design was adopted. Patients (n=9) 65 years and older, who were taking five or more medicines, and had received an invitation from their GP to discuss stopping a medicine, were recruited across four GP practices in Yorkshire and Humber. If patients managed their medicines with the help of a SP, these were also invited to an interview (n=3). Semi-structured interviews were conducted with participants immediately after their deprescribing consultation, and again five to six weeks later (n=24). This enabled the elicitation of the patients' experiences of the initial consultation, and their experiences of stopping medicines in the follow-up period. Interviews lasted approximately 30 minutes, were audio-recorded and analysed using Framework Analysis and underpinned by the Theoretical Domains Framework (TDF - a behaviour change framework).
Several barriers were identified, such as habitual and emotional attachments to medicines, inadequate support and guidance, and a lack of involvement from clinicians throughout the deprescribing process. Patients and their SPs expressed a lack of knowledge and understanding as to the reasons behind reducing their medication, and the benefits for doing so. Post-appointment, patients and their SPs conveyed a sense of abandonment due to the absence of a clear plan or follow-up support conveyed in the following quote “...I’m left alone now. Yes. I’m left alone now...”.
The exploratory nature of this research provides insight into the barriers older people with frailty and their SPs face when reducing or stopping their medicines. It is part of a wider body of research on deprescribing that will inform the development and design of interventions aimed at safely implementing deprescribing within primary care. This research is particularly timely, given both the global and national aim to improve medicines safety outlined in the World Health Organisation’s ‘Medicines Without Harm’ Programme (2017).