Doctor–Patient Deprescribing Conversations: A Multidisciplinary Analysis of Quality Assurance Recordings

Abstract

Previous work in deprescribing interactions primarily involved surveys, interviews or reviews; there is a gap in utilizing real-time doctor–patient communication to understand what strategies physicians use to deprescribe and how patients respond. To move research methodology in this direction, our multidisciplinary team brought together professionals from biomedical, cognitive and social sciences to collaborate with a primary care practice and analyse nine quality-assurance recordings of doctor–patient visits. Eligible patients were 60 years or older and prescribed two or more medications. Through collaborative mixed-method analysis, we identified outcomes and themes of deprescribing conversations. An additional layer of analysis was conducted based on qualitative interviews with two deprescribing physicians for a conversation about physicians' decision-making process in initiating and responding to patient concerns in the interaction. Interplay between patient, physician and system factors was noted, highlighting the key role of health care team collaboration to support deprescribing. Our innovative research design enables a better understanding of deprescribing processes in a primary care setting and has implications for future research including patients, caregivers and community providers.