How this fits in

While there is robust evidence for the benefits of prescribing antihypertensive medication in healthy older patients, the balance of probable benefit against potential risk is less certain in older patients with multimorbidity. An emphasis on the importance of clinical judgement in prescribing decisions for such patients, seen for example in recent revisions to the Quality and Outcomes Framework (QOF) to support person-centred treatment goals, is not yet highlighted in specific guidelines on how to attempt medication reduction. In this examination of how GPs develop and apply their clinical judgement in relation to medication reduction in older patients with multimorbidity, decisions to deprescribe were typically based on clear trigger events or direct requests from patients. GPs found it far harder to come to a decision to deprescribe in response to a generalised concern about polypharmacy: here, experiential knowledge, accrued over time and through multiple sources (mindlines), was critical to developing confidence in deprescribing in the absence of robust medication reduction guidelines.