title: Clinical provider perceptions of proactive medication discontinuation.
abstract: OBJECTIVE
  Polypharmacy and adverse drug events lead to considerable healthcare costs and morbidity, yet there is little to guide clinical providers in the area of discontinuing medications that may not be necessary. We sought to understand providers' beliefs and attitudes about polypharmacy and medication discontinuation.
  
  
  METHODS
  Qualitative study using semi-structured interviews of 20 providers with prescribing privileges at 2 US Veterans Affairs Medical Centers, from April 2012 to October 2012.
  
  
  METHODS
  Transcribed interviews were analyzed using grounded thematic analysis, a systematic approach to deriving qualitative themes from textual data.
  
  
  RESULTS
  We identified 10 themes within 4 domains of medication discontinuation. Within the first domain (medication factors), we identified 2 themes: 1) medication characteristics, and 2) uncertainties of why a patient was taking a particular drug. Within the second domain (patient factors), we identified 3 themes: 3) clinical picture of the patient, 4) clinicians' understanding of the patients' knowledge and beliefs, and 5) patients' adherence. Within the third domain (clinical provider factors), we identified 2 themes: 6) professional identity, and 7) providers' decisions related to their own beliefs about medications. Within the fourth domain (system factors), we identified 3 themes: 8) multiple providers, 9) workload, and 10) external directives and policies such as structural components of a healthcare system.
  
  
  CONCLUSIONS
  Provider decisions to discontinue medications are affected by factors at all levels of the clinical encounter. Our findings have implications for development and implementation of interventions to improve appropriate medication discontinuation via enhanced medication reviews, enriched patient-provider communication, and better system-level structures. This, in turn, may reduce the continued prescribing of potentially inappropriate medications that can lead to adverse outcomes or increased healthcare costs.
authors.affiliation: VA Boston Healthcare System, 150 S Huntington Ave, Bldg 9, Rm 425 (152G), Boston, MA 02130. E-mail: amy.linsky@va.gov.
authors.forename: Amy
authors.initials: A
authors.lastname: Linsky
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Marcello
authors.forename: Barbara
authors.initials: B
authors.lastname: Bokhour
mesh_terms: D001291:Attitude of Health Personnel; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D010349:Patient Compliance / Q000523:psychology*; D010465:Perception; D019338:Polypharmacy; D036301:Qualitative Research; D016312:Treatment Refusal / Q000523:psychology*; D014481:United States; D014493:United States Department of Veterans Affairs