(284) Attitudes and barriers to deprescribing in general practice: the perspective of general practitioners.

Background: General practitioners (GPs) should regularly review patients' medications and consider deprescribing, when necessary, as inappropriate treatments may negatively impact on patients' health.

Objectives: The objective of this study was to assess the perceptions of deprescribing and the barriers to its implementation among Italian GPs.

Methods: GPs were invited to participate in an online survey consisting of 20 questions about deprescribing process in daily clinical practice.

Results: We collected 617 answers during 8 months. Responders were balanced by sex (49.7% female, 50.3% male) and well distributed in 3 age ranges by years of experience (22.9% with < 5 years of experience, 32.3% 5-25 years of experience and 44.9% with >25 years of experience). Overall, less than 2.0% (N=11) of GPs do not implement deprescribing interventions in daily practice because of missing updated formation (N=6) and insufficient experience (N=7). Otherwise, 23.0% reported to implement deprescribing often/very often, with no significant differences between genders and across years of experience, and mainly addressed to patients over 80 years old. Regarding specific therapies, cardiovascular drugs are the less commonly deprescribed (21.2% for statins and 17.9% for antihypertensives), while proton pump inhibitors (PPIs) are the most deprescribed drugs (51.8%). Interestingly, male GPs tend to discontinue benzodiazepines more frequently than female GPs (p < 0.05). GPs reported that triggers in deprescribing process are mainly variations of the risk-benefit ratio considering comorbidities and polytherapy (83.3%), and potential adverse drug reactions linked to chronic therapies (77.6%). Furthermore, the assessments made by GPs in this process are mainly based on each patient's specific case or personal experiences (89.6% and 44.9%, respectively), rather than on the use of guidelines and appropriateness criteria (41.6% and 14.0% respectively). Among barriers, GPs reported difficulties in dealing with specialists (71.3%), mistrust of patient in interrupting medication (53.4%), poor availability of deprescribing guidelines (38.6%), and time constraints in daily practice (34.9%).

Conclusions: The present study confirms the increasing awareness among GPs regarding the importance of deprescribing process, particularly in multi-morbid elderly patients with polypharmacy. However, GPs pointed out some limitations to the effectively implementation of the deprescribing process in the routine clinical practice, especially the lack of specific guidelines. These gaps should be addresses by the institutions through appropriate facilitation measures.