title: Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis.
abstract: OBJECTIVE
  To synthesise qualitative studies that explore prescribers' perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults.
  
  
  METHODS
  A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings.
  
  
  METHODS
  All healthcare settings.
  
  
  METHODS
  Medical and non-medical prescribers of medicines to adults.
  
  
  RESULTS
  Prescribers' perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults.
  
  
  RESULTS
  21 studies were included; most explored primary care physicians' perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported.
  
  
  CONCLUSIONS
  A multitude of highly interdependent factors shape prescribers' behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the risk of iatrogenic harm.
authors.affiliation: Centre of Research Excellence in Quality & Safety in Integrated Primary-Secondary Care, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia Charming Institute, Camp Hill, Brisbane, Queensland, Australia.
authors.forename: Kristen
authors.identifier: http://orcid.org/0000-0002-1937-2416
authors.initials: K
authors.lastname: Anderson
authors.affiliation: School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Stowasser
authors.affiliation: Charming Institute, Camp Hill, Brisbane, Queensland, Australia School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Freeman
authors.affiliation: Centre of Research Excellence in Quality & Safety in Integrated Primary-Secondary Care, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Scott
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003657:Decision Making; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000639:trends; D061214:Patient Safety
keywords: GERIATRIC MEDICINE; QUALITATIVE RESEARCH