Factors influencing providers' willingness to deprescribe medications

Background Polypharmacy (taking >= five medications) is common and associated with adverse drug events, medication nonadherence, and increased mortality and healthcare costs. Primary care providers are uniquely positioned to deprescribe unnecessary medications, yet little is known about factors that influence their deprescribing decisions. Objectives We sought to identify factors that influence primary care providers' recommendations to deprescribe potentially unnecessary medications. Methods This study represents a secondary data analysis from a national, cross-sectional survey assessing providers' beliefs, attitudes, and experiences regarding medication deprescribing. A random sample of 2475 providers in Veterans Affairs (VA) primary care clinics were invited; 411 responded (16.6% response rate). Respondents included physicians (n = 304), nurse practitioners/physician assistants (n = 68), and clinical pharmacists (n = 39). Respondents estimated the proportion of their patients taking a potentially unnecessary medication. Of these patients, providers then identified the proportion for whom they recommended medication deprescribing (response options: <20%, 20%-39%, 40%-59%, 60%-79%, >= 80%). We used multivariable logistic regression to determine factors associated with recommending deprescribing to >= 80% of candidate patients. Results Although most respondents indicated having patients taking unnecessary medications, less than one-third reported recommending deprescribing to most (>= 80%) of their candidate patients. In adjusted analyses, factors significantly associated with increased likelihood of recommending deprescribing included having more patients who asked for medication information, providers' self-rated comfort with deprescribing, and having support to monitor patients after deprescribing. When the indication for a medication was unclear, providers reported being less likely to recommend deprescribing. Conclusion Most providers indicated caring for patients taking potentially unnecessary medications, yet they did not consistently say they recommended deprescribing to these patients. Our findings suggest that requiring prescriptions to include their reason for use and models of primary care designed to strengthen interdisciplinary teamwork and communication, such as the patient-centered medical home, could address barriers providers face to deprescribing medications.