چکیده (انگلیسی):

Background:General Practitioners (GPs) are responsible for primary prescribing decisions in most settings. Elderly
patients living in Advanced Care Facilities (ACFs) often have significant co-morbidities to consider when selecting
an appropriate drug therapy. Careful assessment is required when considering appropriate medication use in frail
older patients as they have multiple diseases and thus multiple medication. Many physicians seem reluctant to
discontinue other physicians’ prescriptions, resulting in further polypharmacy. Therefore it is relevant to ascertain
and synthesise the GP views from multiple settings to understand the processes that might promote appropriate
deprescribing medications in the elderly.
The aims of this study were to 1) compare and contrast behavioural factors influencing the deprescribing practices
of GPs providing care for ACF residents in two separate countries, 2) review health policy and ACF systems in each
setting for their potential impact on the prescribing of medications for an older person in residential care of the
elderly, and 3) based on these findings, provide recommendations for future ACF deprescribing initiatives.
Methods:A review and critical synthesis of qualitative data from two interview studies of knowledge, attitudes, and
behavioural practices held by GPs towards medication management and deprescribing for residents of ACFs in
Australia and Sweden was conducted.
A review of policies and health care infrastructure was also carried out to describe the system of residential aged
care in the both countries.
Results:Our study has identified that deprescribing by GPs in ACFs is a complex process and that there are
numerous barriers to medication reduction for aged care residents in both countries, both with similarities and
differences. The factors affecting deprescribing behaviour were identified and divided into: intentions, skills and
abilities and environmental factors.
Conclusions:In this study we show that the GPs’ behaviour of deprescribing in two different countries is much
dependent on the larger health care system. There is a need for more education to both GPs and ACF staff as well
as better cooperation between the different health care systems and appropriate monetary incentives for elderly
care to achieve better conditions for deprescribing practice.