Respiratory medicine · 2025
Barriers and enablers to deprescribing for people living with cystic fibrosis: Multidisciplinary perspectives.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Lord Louise, Langford Aili, Wang Taian, Shaw Grace, Ilomaki Jenni, Reeve Emily, Turner Justin
Аннотация
BACKGROUND: Cystic fibrosis (CF) is a complex genetic disorder necessitating extensive treatment regimens leading to significant medication burden. The recent use of modulator therapies have questioned the necessity of traditional CF treatments, prompting re-evaluation of strategies to reduce treatment burden. This study aimed to identify the barriers and enablers to deprescribing from the perspectives of doctors, nurses, and pharmacists caring for people with CF (PwCF).
METHODS: A qualitative study design employing semi-structured interviews was utilised. Healthcare practitioners (HCPs) across Australia were recruited and interviewed. Interviews were transcribed and analysed using NVivo 1.3 software, guided by an existing framework focusing on self-efficacy, feasibility, inertia, and awareness.
RESULTS: Eleven HCP participated (doctors, n = 3, nurses, n = 4, pharmacists, n = 4). Low self-efficacy was the most prominent barrier to deprescribing, founded on a perceived lack of evidence. Feasibility was an enabler when patient factors were present, particularly PwCF's experiences of reducing medications independently. Likewise, the presence of pharmacists in CF clinics and multidisciplinary team meetings were identified as facilitators. Inertia to continue entrenched prescribing habits and fear of adverse outcomes deterred deprescribing. Similarly, HCPs reported having little awareness of the need for deprescribing in daily practice, as their primary focus was on addressing acute problems.
CONCLUSIONS: Enhancing self-efficacy through evidence-based guidelines and increasing feasibility by fostering collaborative approaches among HCPs and PwCF may improve deprescribing practices in CF care. As evidence on the benefits and safety of deprescribing grows, it should be integrated into clinical guidelines to alleviate medication burden and improve quality of life for PwCF.
METHODS: A qualitative study design employing semi-structured interviews was utilised. Healthcare practitioners (HCPs) across Australia were recruited and interviewed. Interviews were transcribed and analysed using NVivo 1.3 software, guided by an existing framework focusing on self-efficacy, feasibility, inertia, and awareness.
RESULTS: Eleven HCP participated (doctors, n = 3, nurses, n = 4, pharmacists, n = 4). Low self-efficacy was the most prominent barrier to deprescribing, founded on a perceived lack of evidence. Feasibility was an enabler when patient factors were present, particularly PwCF's experiences of reducing medications independently. Likewise, the presence of pharmacists in CF clinics and multidisciplinary team meetings were identified as facilitators. Inertia to continue entrenched prescribing habits and fear of adverse outcomes deterred deprescribing. Similarly, HCPs reported having little awareness of the need for deprescribing in daily practice, as their primary focus was on addressing acute problems.
CONCLUSIONS: Enhancing self-efficacy through evidence-based guidelines and increasing feasibility by fostering collaborative approaches among HCPs and PwCF may improve deprescribing practices in CF care. As evidence on the benefits and safety of deprescribing grows, it should be integrated into clinical guidelines to alleviate medication burden and improve quality of life for PwCF.