General practitioners' decisions about discontinuation of medication: an explorative study.
Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience.
Department of General Practice, Copenhagen University, Copenhagen, Denmark.
Michael Simon
MS
Nixon
Department of Organization, Copenhagen Business School, Copenhagen, Denmark.
Morten Thanning
MT
Vendelø
D000067289:Behavior Observation Techniques; D003657:Decision Making; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D007407:Interviews as Topic; D036301:Qualitative Research; D028761:Withholding Treatment
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
Decision making; Deprescribing; Discontinuation; General practitioners; Institutional context; Medication