Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviors in Primary Care for the Elderly—Qualitative Study
Abstract
:1. Introduction
2. Methods
2.1. Semistructured Interviews
2.1.1. Constitution of the Panel
2.1.2. Process of Semistructured Interviews
2.2. Focus Group
2.3. Data Analysis
2.3.1. Identification of Determinants (Barriers and/or Facilitators) of Appropriate Polypharmacy-Prescribing and -Dispensing Behavior
2.3.2. Identification of Key TDF to Target
2.3.3. Identification and Selection of the Components of the Intervention
3. Results
3.1. Participants’ Characteristics
3.2. Summary of Key Findings from the Identification of Behavior Determinants Stages (Barriers and/or Facilitators)
3.3. Identification of Key Domains
3.4. Selecting the Components of the Intervention
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Evidence from Literature | Semistructured Interviews | Researchers’ Consensus | Focus Group | |
---|---|---|---|---|
1. Identify determinants: barriers and/or facilitators | X | X | ||
2. Select key TDF domains | X | X | X | |
3. Select the components of the intervention (BCTs) | X | X | X | X |
General Practitioners (n = 11) | Pharmacists (n = 6) | |
---|---|---|
Gender Male Female | ||
4 | 5 | |
7 | 1 | |
Years of professional experience | 2–33 | 1–25 |
Activity area | ||
Area 1 | 3 | 1 |
Area 2 | 2 | 1 |
Area 3 | 2 | 1 |
Area 4 | 1 | 1 |
Area 5 | 1 | 1 |
Area 6 | 1 | 1 |
Area 7 | 1 | 0 |
TFD Domains | Knowledge | Skills | Social/Professional Role and Identity | Beliefs About Capabilities | Beliefs about Consequences | Motivation and Goals | Memory, Attention and Decision Processes | Environmental Context and Resources | Social Influence | Emotion | Behavioral Regulation | Nature of the Behaviors | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Determinants | |||||||||||||
knowledge acquired in initial or continuing training | |||||||||||||
knowledge of geriatric therapeutics | |||||||||||||
Consulting/receiving recommendations | |||||||||||||
keep informed (e.g., by subscription to the journal “Prescrire”) | |||||||||||||
Using databases and software | |||||||||||||
Patient profile: helping or opposing | |||||||||||||
Lack of specific training on communication skills | |||||||||||||
Trusting relationship GP, Pharmacist/Patient: relational aspect, interactions, explanations, shared decision | |||||||||||||
More or less effective communication between prescribers, and between doctors and pharmacists | |||||||||||||
Functioning in a formalized network of professionals | |||||||||||||
GPs conscious or not of their pivotal/oversight role | |||||||||||||
Pharmacists’ belief in their firewall role | |||||||||||||
GPs’ belief in the complementary role of pharmacists | |||||||||||||
Pharmacists’ confidence in GP prescribing | |||||||||||||
GPs feeling comfortable about their role in relation to specialists | |||||||||||||
lack of resources and time | |||||||||||||
Complementary role of home care nurses | |||||||||||||
Lack of formalization of the roles of each in the patient’s pathway | |||||||||||||
Lack of access to the whole information in the patient file | |||||||||||||
Constant concern to avoid iatrogenic: drug interactions and side effects | |||||||||||||
Dealing with short- and long-term consequences | |||||||||||||
Belief that polypharmacy goes hand in hand with polypathology | |||||||||||||
Belief in the impact on drug compliance | |||||||||||||
Benefit-risk balance | |||||||||||||
HCPs Tiredness | |||||||||||||
Patient condition | |||||||||||||
High motivation to systematically check the medication | |||||||||||||
Employing strategies: deferring, explaining, negotiating | |||||||||||||
Being a training supervisor | |||||||||||||
Experience | |||||||||||||
Habit/ chronic patients/ prescription refills | |||||||||||||
Reducing prescription renewal intervals | |||||||||||||
Verification stage before printing the prescription by the GP-double check by the pharmacist when dispensing | |||||||||||||
Sharing a practice with other doctors | |||||||||||||
The feeling of being completely free in prescribing and dispensing | |||||||||||||
Anti-lab generation of GPs | |||||||||||||
Financial aspect for pharmacists | |||||||||||||
Pressure from patient and/or family | |||||||||||||
Patient profile: anxiety patients and psychiatric profiles | |||||||||||||
HCPs’ confidence in their ability to cope with stress | |||||||||||||
Relatively limited access to indicators and statistic |
Domain Label | BCTs Identified from Reference [31] | BCTs Identified from Reference [44] |
---|---|---|
Skills |
|
|
Social/professional role and identity | None |
|
Beliefs about capabilities |
|
|
Motivation and goals |
|
|
Memory, attention, and decision processes | None |
|
Environmental context and resources |
|
|
Social influences |
|
|
Emotion |
|
|
Behavioral regulation |
|
|
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Taghy, N.; Ramel, V.; Rivadeneyra, A.; Carrouel, F.; Cambon, L.; Dussart, C. Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviors in Primary Care for the Elderly—Qualitative Study. Int. J. Environ. Res. Public Health 2023, 20, 1389. https://doi.org/10.3390/ijerph20021389
Taghy N, Ramel V, Rivadeneyra A, Carrouel F, Cambon L, Dussart C. Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviors in Primary Care for the Elderly—Qualitative Study. International Journal of Environmental Research and Public Health. 2023; 20(2):1389. https://doi.org/10.3390/ijerph20021389
Chicago/Turabian StyleTaghy, Najwa, Viviane Ramel, Ana Rivadeneyra, Florence Carrouel, Linda Cambon, and Claude Dussart. 2023. "Exploring the Determinants of Polypharmacy Prescribing and Dispensing Behaviors in Primary Care for the Elderly—Qualitative Study" International Journal of Environmental Research and Public Health 20, no. 2: 1389. https://doi.org/10.3390/ijerph20021389