Facilitating conversations about deprescribing in primary care, a qualitative study

In the province of Quebec, one-third of seniors have pharmacy claims for a drug on the Beers list, a list of drugs identified as potentially inappropriate to prescribe in this population. However, little is known about the conversations between primary care practitioners and older patients around stopping or tapering these inappropriate prescriptions. Benzodiazepines and proton pump inhibitors (PPIs) are the two classes of medications targeted in this study, which aligns with Choosing Wisely Canada’s campaign to help physicians and patients engage in conversations about unnecessary tests and treatments.

This qualitative study investigated communication strategies used in deprescribing conversations between primary care physicians and older adults. The study found that providing patients with education about the benefits and harms of their medication before they saw their family physician resulted in a greater proportion of conversation themes relating to medication use to be initiated by patients (44% versus 17%). The content of deprescribing conversations for PPIs revealed that patients and their healthcare providers focused less on ‘dosage/instructions,’ and more on the ‘medication action and efficacy’ and the necessity for ‘follow up.’ Conversations about stopping benzodiazepines were more likely to stagnate on the ‘if’ rather than the ‘how.’ The initiation, style and content of the conversations varied between PPI and benzodiazepine users, suggesting that healthcare providers will need to tailor deprescribing conversations accordingly.

Lead: Dr. Cara Tannenbaum

Co-investigators: Dr. Marie-Thérèse Lussier, Dr. Claude Richard, Dr. Barbara Farrell, Dr.Justin Turner, Université de Montréal

Contact: camille.gagnon@criugm.qc.ca

Funder (2015-2019): Canadian Institutes of Health Research

Publications:

Turner JP, Richard C, Lussier MT, Lavoie ME, Farrell B, Roberge D, Tannenbaum C. Deprescribing conversations: a closer look at prescriber-patient communication. PubMed, 2018 Oct 20;9(12):687-698. doi: 10.1177/2042098618804490