Barriers and Facilitators to Pharmacist-Led Deprescribing of Antihypertensives in Long-Term Care: A Survey-Based Study

Pharmacist-led deprescribing is an approach of addressing polypharmacy in the long-term care (LTC) setting. However, the sustainability of this practice has not been widely studied. This study describes facilitators and barriers to pharmacist-led deprescribing from pre- and post-surveys completed as part of a randomized controlled antihypertensive deprescribing trial in Alberta, Canada. The surveys, targeting facilitators and barriers to deprescribing, were developed based on current evidence and designed through an iterative process with pharmacist input and consist of open- and closed-ended questions. Nine pharmacists completed both surveys (seven female; five have been a pharmacist ≥10 years; and eight had their Additional Prescribing Authority [authority to prescribe to full scope of practice]). The key facilitators were (1) pharmacist confidence and attitude toward deprescribing, (2) sufficient patient data, and (3) minimal tools and education required. The key barriers included (1) pharmacist perception of not being the primary decision maker on prescribing decisions, (2) insufficient support from residents' families and physicians, and (3) additional time required. These facilitators and barriers were all identified pre-deprescribing, and confirmed, and more evident post-deprescribing. These barriers will make it challenging for pharmacists to incorporate deprescribing antihypertensives into routine care.