The English National Overprescribing Review identified that older people often take eight or more medicines a day. The report recommended pharmacists in primary care should take responsibility for addressing polypharmacy. Overprescribing is a safety concern in care homes as approximately half of older care home residents are prescribed at least one medicine that is unnecessary or now harmful. This predisposes them to adverse outcomes including hospitalisation and mortality. Deprescribing is the planned activity of stopping or reducing a medicine that may no longer be appropriate. Deprescribing, when performed by a pharmacist, is a multidisciplinary activity requiring close communication with general practitioners (GPs) and care home staff. A recently completed trial that integrated pharmacists with prescribing rights into older peoples' care homes found significant variation in proactive deprescribing activity. The aim of the current study was to specifically explore beliefs and practices of deprescribing in care homes. A qualitative approach was adopted to examine individual, social and contextual factors that acted as enablers and barriers to pharmacist deprescribing in care homes. Semi-structured interviews were conducted with participants of the previous study (16 pharmacists, 6 GPs and 7 care home staff from Northern Ireland, Scotland and England). Using thematic analysis, we identified two themes: (a) Structures and systems affecting deprescribing, that is the context in which deprescribing happened, including team involvement and routine practices in GP surgeries and care homes; (b) Balancing risks when deprescribing, that is the perception of individual risk and social barriers were mitigated by understanding the medical background of residents. This supported the clinical understanding that risks from overprescribing were greater than risks from deprescribing. While deprescribing can involve all health professionals in the primary care team, these results suggest the pharmacist is well placed to lead the process; by having both clinical competence and professional willingness to drive this activity forward.

中文翻译：

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加强去处方：对护理院中药剂师主导的去处方的复杂性的定性理解

英国国家过度处方审查发现，老年人经常每天服用八种或更多药物。该报告建议初级保健中的药剂师应该负责解决多重用药问题。过度开药是养老院的一个安全问题，因为大约一半的养老院居民至少开了一种不必要或现在有害的药物。这使他们容易出现不良后果，包括住院和死亡。取消处方是停止或减少可能不再适用的药物的计划活动。当由药剂师执行时，开具处方是一项多学科活动，需要与全科医生 (GP) 和护理院工作人员密切沟通。最近完成的一项试验将具有处方权的药剂师纳入老年人的 护理院发现主动去处方活动存在显着差异。本研究的目的是专门探讨护理院中取消处方的信念和做法。采用定性方法来检查个人、社会和背景因素，这些因素是药剂师在护理院中取消处方的推动因素和障碍。对先前研究的参与者（来自北爱尔兰、苏格兰和英格兰的 16 名药剂师、6 名全科医生和 7 名护理院工作人员）进行了半结构化访谈。通过主题分析，我们确定了两个主题：(a) 社会和背景因素是药剂师在护理院中取消处方的推动因素和障碍。对先前研究的参与者（来自北爱尔兰、苏格兰和英格兰的 16 名药剂师、6 名全科医生和 7 名护理院工作人员）进行了半结构化访谈。通过主题分析，我们确定了两个主题：(a) 社会和背景因素是药剂师在护理院中取消处方的推动因素和障碍。对先前研究的参与者（来自北爱尔兰、苏格兰和英格兰的 16 名药剂师、6 名全科医生和 7 名护理院工作人员）进行了半结构化访谈。通过主题分析，我们确定了两个主题：(a)影响取消处方的结构和系统，即取消处方发生的背景，包括全科医生手术和护理院的团队参与和常规做法；(b)在开处方时平衡风险，即通过了解居民的医疗背景来减轻个人风险和社会障碍的感知。这支持了临床上的理解，即过度开药的风险大于取消开药的风险。虽然取消处方可能涉及初级保健团队中的所有卫生专业人员，但这些结果表明药剂师完全有能力领导这一过程；通过具有临床能力和专业意愿来推动这项活动向前发展。