Pharmacy Daily | Action needed on deprescribing barriers

RESEARCH led by Monash University and published in the British Journal of Clinical Pharmacology has found that while most community pharmacists routinely dispense high risk psychotropic medicines, fewer than half initiated discussions on deprescribing.

However, they also found that most pharmacists said they were comfortable about intervening when concerned about the drugs, despite the low rate of initiating discussions around tapering.

With pharmacist-led deprescribing interventions playing a key role in mitigating harms from certain high-risk psychotropics, the researchers set out to learn more about the practices and perspectives of community pharmacists around such initiatives, pointing out that they were not well understood.

The team conducted a nationwide survey of 730 community pharmacists, with around 12% of community pharmacies represented.

Participants were asked about their provision of high-risk psychotropic medicines, including opioid analgesics, benzodiazepines, gabapentinoids and medicinal cannabis, as well as their perspectives, confidence and practices related to implementing strategies to support deprescribing of these medicines.

Approximately three-quarters stated their pharmacy received prescriptions daily for opioids (81%), benzodiazepines (75%) and gabapentinoids (72%), though only 9% received medicinal cannabis prescriptions every day.

However, for each of the medicines, fewer than half said they had initiated a conversation about deprescribing, and a third said they had not talked about deprescribing for any of the four medicines.

Pharmacists working outside of capital cities, pharmacy managers/owners and those with 15 or more years of professional experience were more likely to initiate discussions on deprescribing psychotropic medicines compared with those working in capital cities, employee pharmacists and those with less than 15 years of professional experience.

The team acknowledged the findings may partly reflect a clinical context in which deprescribing is not always appropriate, such as when opioids are prescribed long-term for cancer pain or palliative care and gabapentinoids for seizure management.

"Nevertheless, the limited engagement observed may also indicate broader barriers constraining pharmacists' capacity to support deprescribing initiatives," they stated, pointing to barriers such as lack of support, resources and education and fear of negative consequences.

"Our findings, therefore, highlight the need for strategies that address practice-related barriers as well as structural and systemic barriers to strengthen pharmacists' role in supporting deprescribing in clinical practice," they concluded.

Read the research HERE. KB