Barriers and enablers to deprescribing for older people in care homes: The theory-based perspectives of pharmacist independent prescribers

Alharthi, Mohammed, Wright, David, Scott, Sion and Birt, Linda (2023) Barriers and enablers to deprescribing for older people in care homes: The theory-based perspectives of pharmacist independent prescribers. Research in Social and Administrative Pharmacy, 19 (5). pp. 746-752. ISSN 1551-7411

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Abstract

Background: Over 70% of care home residents are prescribed potentially inappropriate medications (PIMs) associated with morbidity and mortality. Deprescribing is a common recommendation by pharmacists performing medication reviews in care homes, however requiring prescriber authorisation is a barrier. Care home Independent Pharmacist Prescribing Study (CHIPPS), a cluster randomised control trial integrated pharmacist independent prescriber (PIPs) into care homes to improve medication management, providing a unique opportunity to identify their barriers and enablers to deprescribing.  Objectives: To identify barriers and enablers to PIPs deprescribing medications in care homes.  Methods: Secondary qualitative framework analysis was performed on interviews with CHIPPS’ PIPs. A maximum variation sampling approach was used to select from the 14 PIPs included in the process evaluation to achieve diversity of PIPs' contextual factors e.g., previous experience in care homes. Transcripts were coded inductively for barriers and enablers to deprescribing and then mapped to Theoretical Domains Framework (TDF).  Results: Eleven PIP's interviews were sampled. Factors acted as enablers and barriers were PIP relationship with General Practitioner (GP), care home staff and residents/families, awareness of the PIP role and family trust in PIPs' deprescribing activities (social influences); PIPs' independent prescribing confidence, previous experience and ability dealing with residents' medications (beliefs about capabilities); understanding of PIP role and PIP confidence in their role as an independent prescriber (Social/professional role and identity); access to residents' records, deprescribing decision support, regular follow-up from care home staff, resident difficulties with medications, teamwork, and time restraints (Environmental context and resources). One factor acted as a barrier: believing negatives of deprescribing outweigh benefits regarding certain medications (Beliefs about consequences).  Conclusion: PIPs' involvement in deprescribing within care homes is influenced by multiple barriers and enablers. Data mapped to TDF domains represent barriers that need addressing and enablers that should be highlighted to enhance PIPs' effectiveness in future interventions.

Item Type:	Article
Uncontrolled Keywords:	deprescription,pharmacist independent prescriber (pip),polypharmacy,pharmacy,pharmaceutical science ,/dk/atira/pure/subjectarea/asjc/3600/3611
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences Faculty of Science > School of Chemistry, Pharmacy and Pharmacology
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	16 Jan 2026 12:30
Last Modified:	18 Jan 2026 07:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101629
DOI:	10.1016/j.sapharm.2023.01.013

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