Implementation of a deprescribing guideline by community pharmacists: A focus group study

Abstract

Background: Polypharmacy is common in older adults and, independent of underlying multimorbidity, is associated with adverse drug events, reduced quality of life, and increased healthcare use. Deprescribing can help address these issues. Pharmacists can identify deprescribing opportunities during clinical medication reviews (CMRs), and guidelines may support this process. However, their impact depends on successful implementation. Objectives: To identify determinants relevant for the implementation of this deprescribing guideline based on CPs' experiences with its use in clinical practice. Methods: Online focus groups were held with community pharmacists from the intervention group of a cluster randomized trial evaluating guideline-assisted deprescribing during CMRs in older patients with hyperpolypharmacy (≥10 medications). Pharmacists received training on the guideline and its drug-specific fact sheets. The topic guide was informed by the Tailored Implementation for Chronic Diseases (TICD) checklist. Transcripts were deductively coded and analysed thematically. Results: Nineteen of 24 eligible pharmacists participated in three focus groups. Across seven TICD domains, 26 determinants were identified. There were few barriers related to the guideline itself, with pharmacists appreciating the layered structure and summaries and applicability of recommended interventions. At personal level, their ability to identify deprescribing opportunities and to monitor clinical outcomes was considered relevant. At patient level, barriers included limited knowledge and ambivalent attitudes. Key influences regarding professional interaction included general practitioners' familiarity with deprescribing, clarity of task allocation, and interprofessional trust. Regarding resources insufficient reimbursement, and lack of integrated decision support were reported as barriers. Conclusions: Drug-specific fact sheets support deprescribing but do not fully address the complexity of decision-making in practice. Implementation is influenced by clinical uncertainty, experience, interprofessional collaboration, and organisational factors. Strengthening decision support, collaboration, and organisational conditions is essential for sustainable implementation.