TABLE A2.
Nonconsensus barrier statements
| TDF | Barrier statements | Minimum | Median | Maximum | IQR |
|---|---|---|---|---|---|
| Physician‐related | |||||
| Knowledge | Lack of awareness of medication cost | Low (15%) | Moderately (45%) | Very (15%) | 2 |
| Lack of formal education on prescribing for and treatment of the elderly | Low (5%) | Moderately (40%) | Very (35%) | 1.5 | |
| Skills | Limited applicability of research findings in day‐to‐day clinical work | Slightly (10%) | Moderately (30%) | Extremely (10%) | 1.5 |
| Social/professional role and identity | Physicians imposing their own beliefs onto the patient without consideration for the latter (no shared decision making) | Low (5%) | Moderately (50%) | Extremely (5%) | 1.5 |
| Dilemma between economic responsibility for both patients and society | Low (30%) | Neutral (45%) | Very (10%) | 2 | |
| Unwillingness to change recommendations from secondary/tertiary care | Not at all (5%) | Moderately (35%) | Extremely (5%) | 2 | |
| Varying acceptance of pharmacists’ recommendation | Not at all (5%) | Neutral (40%) | Very (10%) | 1.5 | |
| Beliefs about consequences | *Fear of “giving up on the patient” | Low (11%) | Moderately (47%) | Extremely (5%) | 2 |
| Viewing the deprescribing process as a risk to be avoided | Low (15%) | Neutral (25%) | Very (10%) | 2 | |
| Memory, attention, and decision‐making processes | Feeling forced to prescribe | Low (20%) | Slightly & Neutral (30%), (25%) | Moderately (25%) | 1.5 |
| Environmental context and resources | Increased risk of ADRs and drug–drug interactions | Low (5%) | Moderately (25%) | Very (30%) | 3 |
| Difficulty in distinguishing between new complaints and medication side effects | Low (10%) | Moderately (45%) | Very (30%) | 1.5 | |
| Pressure from guidelines vs individual patient circumstances | Low (20%) | Moderately (50%) | Very (15%) | 2 | |
| Uncertainty about patients who may be eligible for a medication review | Low (15%) | Neutral (25%) | Very (15%) | 2 | |
| Physicians themselves may be influenced by pharmaceutical drug representatives | Not at all (5%) | Neutral (35%) | Moderately (25%) | 2.5 | |
| Lack of access to a pharmacist (to assist with medication review) | Not at all (10%) | Neutral (25%) | Very (5%) | 3 | |
| Lack of available tools/strategies to help quantify benefits and harms | Slightly (10%) | Moderately (40%) | Extremely (15%) | 2 | |
| Social influences | Culture to prescribe more | Not at all (5%) | Neutral (25%) | Extremely (5%) | 2 |
| Lack of peer support (ie, medication review) | Low (25%) | Neutral (30%) | Moderately (35%) | 2.5 | |
| Peer influence | Not at all (5%) | Neutral (45%) | Very (10%) | 1.5 | |
| Emotion | Choosing to maintain the patient–doctor relationship rather than enforce changes or recommendations and threatening that relationship | Not at all (5%) | Neutral & Moderately (20%), (50%) | Moderately (50%) | 2.5 |
| Patient‐related | |||||
| Environmental context and resources | Unintentional withholding of ADRs because they attribute these to aging rather than side effects of medications | Not at all (10%) | Neutral (20%) | Moderately (35%) | 2 |
| Patients are more likely to report symptoms to hospital specialists rather than GPs | Not at all (5%) | Neutral (40%) | Very (10%) | 1.5 | |
| Some patients “love taking medications” | Low (10%) | Moderately (50%) | Very (15%) | 1.5 | |
| Healthcare system–related | |||||
| Environmental context and resources | Data lost in the transition from written notes to electronic prescriptions | Low (5%) | Moderately (50%) | Very (10%) | 1.5 |
| Influences of prescribing policy (perception of managerial meddling and cost cutting) | Not at all (5%) | Neutral (45%) | Very (5%) | 2 | |
| Limited options on healthcare organization formularies | Not at all (10%) | Low (45%) | Moderately (5%) | 2 | |
| Lack of data for outcomes most important to patients (eg, improvement in pain control | Low (10%) | Moderately (55%) | Extremely (5%) | 1.5 | |
| Difficulty in managing direct‐to‐consumer commercials about drugs and their impact on patients | Low (25%) | Neutral (65%) | Moderately (5%) | 1.5 | |
*
Only 19 responses for this statement due to missing data.