Proactive Deprescribing Among Older Adults With Polypharmacy: Barriers and Enablers.

Abstract

Purpose: Understanding patients' perspectives and readiness regarding deprescribing-a concept broader than mere drug cessation, encompassing dynamic interaction between patients and health care professionals-is essential for developing feasible and effective deprescribing interventions. The goal of our study was to qualitatively explore the perspectives of older adults regarding proactive deprescribing, as well as its barriers and enablers.

Methods: We conducted semistructured interviews with 20 patients in Japan aged 65 years or older who were receiving 5 or more regular medications to explore their perceptions and experiences related to deprescribing. The interviews were transcribed and the data were thematically analyzed to identify major concepts.

Results: Placing a low value on medication was an important trigger of patients' proactive attitudes toward deprescribing. Patients were open to deprescribing conversations if they trusted the prescriber. Conversely, patients who had a positive perspective on medication or considered themselves incapable of participating in decision making preferred to defer to a physician. On the basis of medication valuation, decision-making preferences, and openness to deprescribing, we developed a new typology with 5 types of patients: indifferent (15% of study patients), satisfied and risk-averse (10%), compliant (30%), fearful but passive (20%), and proactive (25%).

Conclusions: Patients' attitudes toward deprescribing varied considerably according to their medication valuation, preference for involvement in decision making, and openness to deprescribing. Focusing on patients' proactiveness and understanding these barriers and enablers is essential for patient-centered decision making and for developing strategies to optimize the appropriateness of medication.