Table 3.
The domain of reinforcement
| Reinforcement to deprescribing activities and collaboration | ||
|---|---|---|
| Belief (as expressed by professional group) |
Quote No. | Quote and speaker (indicating professional group, participant ID and sex e.g. GP1M = General practitioner 1, male) |
| GPs are reprimanded for deprescribing actions (GP) | 24 | GP13M: The biggest problem for me is the contact with other specialists, especially cardiologists. When I deprescribe a 90-years old patient’s statin (…), the guy [cardiologist] rips me into shreds, this idiot GP who doesn’t know the first thing, deprescribing the statin! He could die from this AND get a heart attack and so on. Then it’s difficult. And when I know this I won’t deprescribe anything. Because, this scolding -I mean, I can take a lot. But at some point, I need to draw a line. |
| CP’s medication optimization efforts are not valued (CP, GP) | 25 | CP19F: In 80% of the cases, one is treated with disrespect for this kind of feedback [on interaction checks]. I had it only once in my career I heard a doctor saying ‘I appreciate your call.’ (…) Once! In 20 years! |
| 26 | GP10M: I receive a fax from the pharmacist every time something doesn’t fit together (…) this know-it-all fax: here, look, you’ve prescribed the wrong stuff together again (…) when you’ve thought it through and now there’s this fax … | |
| 27 | GP13M: When I see a medical indication and prescribe an antidepressant but didn’t get that [the patient] already has QT-prolonging medication, then I need feedback, somebody who says: Stop! Do you know what you’re doing here? Then I receive a telefax. And I appreciate that. | |
| 28 | GP17M: How do we manage all this without offending anybody? The pharmacist’s got the expertise, but the physician doesn’t want anybody to interfere. | |
| 29 | GP4M: I’m not crazy about pharmacists, because it’s such a giant commerce. I don’t believe they represent my key contact for deprescribing strategies or such things, because they want to sell it [the medications]. | |
| 30 | CP12F: Every unit of medications less prescribed means for the pharmacist: Less sales. Our salary is measured by unit volume! Really! The better we consult, the more we cooperate with you, the less profit we make. In other words: we do the right thing, and we get less for it. And that’s our core problem! | |
Legend: GP General practitioner, CP Community pharmacist, CS Community specialist