Title: Barriers and Enablers to Deprescribing in Long-term Care Facilities: A Qualitative Investigation Into the Opinions of Healthcare Professionals in Ireland
Stream: Frailty
Presentation Type: Virtual Presentation
Authors:
Clara Heinrich, University College Cork, Ireland
Sheena McHugh, University College Cork, Ireland
Suzanne McCarthy, University College Cork, Ireland
Maria Donovan, University College Cork, Ireland
Abstract:
Introduction: The prevalence of polypharmacy increases with age, increasing the exposure of older adults to potentially inappropriate medication (PIMs). Deprescribing has been shown to reduce PIMs for older residents in long-term care; however, deprescribing is not universally implemented. This study aims to identify the barriers and enablers to deprescribing in Irish long-term care facilities (LTCFs) from the healthcare professionals’ (HCPs) perspective.
Methods: A qualitative descriptive approach was conducted using semi-structured interviews with HCPs working with LTCFs (general practitioners, pharmacists and nurses). Purposive sampling with maximum variation was applied to select sites, supplemented with convenience sampling of post-graduate HCPs from University College Cork. The analytical strategy involved two processes. Data were analysed inductively to develop themes, then these were mapped to the theoretical framework of deprescribing barriers and enablers, developed through qualitative evidence synthesis informed by the Theoretical Domains Framework.
Results: Twenty-six HCPs participated from 13 LTCFs. The main barriers and enablers identified mapped to five domains. Barriers included insufficient resources, lack of co-ordination between healthcare settings and negative social influences. Additional barriers exist in private LTCFs including deprescribing awareness, commitment and the need for incentives. Deprescribing enablers included education, interprofessional support, and involving patients in decision making. Potential enablers include HCP education, pharmacist role expansion and tailored deprescribing guidelines within a structured process.
Conclusion: Interventions to support deprescribing should build on existing systems, involve stakeholders and utilise guidelines within a structured process. Any intervention must account for the nuanced barriers and enablers which exist in both public and private settings.
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