Determinants of Implementing Deprescribing for Older Adults in English Care Homes: A Qualitative Study

Abstract

Abstract Background Care home residents often have multiple long-term conditions and experience polypharmacy. However, some medicines may be unnecessary or may cause more harm than good, especially as residents develop increasing frailty. Previous research has found that deprescribing (the reduction or stopping of prescription medicines that may no longer be providing benefit) is generally safe, but it is not known how to make it work well in care homes. Implementation of deprescribing for care home residents can be challenging due to different stakeholders’ concerns and differences in management structures. The paper reports on an investigation of factors that may help or hinder deprescribing practice within care homes. Methods Semi-structured interviews with care home staff, residents, family members, and healthcare professionals were conducted regarding their experiences and perceptions of deprescribing. The design, data collection, and framework analysis were informed by the Consolidated Framework for Implementation Research. Results Thirty-six semi-structured interviews were conducted with 23 care home staff, 8 residents, 4 family members, and 1 general practitioner. Major themes concerned deprescribing as a complex process and internal and external contextual factors influencing deprescribing practice, including beliefs, abilities, and relationships. The quality of local relationships with and support from healthcare professionals were more crucial factors than the type of care home management structure. Conclusions Several influencing factors need to be considered for implementing deprescribing for older adults in care homes. Further work is warranted to design and implement a deprescribing approach which addresses these determinants. Deprescribing implemented safely and successfully in care homes can benefit residents and the wider health economy.