Table 1.
Summarizing the barriers to routine deprescribing.
| 1 | • General: myths and pressures |
| • Emotional/psychological global beliefs: doctors heal diseases by drugs • Traditional sometimes prejudiced myths: there is a medicine for each disease • Taking medications to treat or prevent disease is ‘a must’ for most adults • Diagnostics and drug companies’ propaganda and pressure on the public, doctors, HMOs and patients • Doctors/researchers on for-profit companies and their publications/lectures may be biased to say the least |
|
| 2 | • Doctors’ fears, restraints and frustration |
| • Underappreciation of the scale of IMUP-related harm • Must follow current CPGs (also pay for performance issues), though there are no EBM-proven CPGs for older people, particularly VOCODFLEX • Reluctance to discontinue medication due to fear of unfavorable consequences even if unrelated to deprescribing (age related, disease related etc.) • Fear of lawsuits if they do not precisely follow current CPGs at all age groups • Fear of their superiors/managers if they do not follow CPGs at all age groups • Fear of the patient/family if they dare stop drugs recommended by experts • No EBM RCTs indicating when to stop medications • Uncertainty regarding the effectiveness of strategies to reduce polypharmacy |
|
| 3 | • Patient/family role and pressure |
| • Give me something/what will you give me instead? • The ‘expert’ (Prof., department head, private, hospital doctor) prescribed it, who are you (the GP) to question/change it? Many disregard GPs’ advice to deprescribe • Underappreciation of the scale of IMUP-related harm • Some may suspect any attempt of GPs to stop medications is the result of economical incentives only; in other words, pressure on the GPs from their HMO management or insurance companies to save money |
CPG, clinical practice guideline; EBM, evidence-based medicine; GP, general practitioner; HMO, health maintenance organization; IMUP, inappropriate medication use; RCT, randomized controlled trial; VOCODFLEX, very old, with comorbidity, dementia, frailty, or limited life expectancy.