title: Self-efficacy for deprescribing: A survey for health care professionals using evidence-based deprescribing guidelines.
abstract: Although polypharmacy is associated with significant morbidity, deprescribing can be challenging. In particular, clinicians express difficulty with their ability to deprescribe (i.e. reduce or stop medications that are potentially inappropriate). Evidence-based deprescribing guidelines are designed to help clinicians take action on reducing or stopping medications that may be causing more harm than benefit.
  
  
  
  Determine if implementation of evidence-based guidelines increases self-efficacy for deprescribing proton pump inhibitor (PPI), benzodiazepine receptor agonist (BZRA) and antipsychotic (AP) drug classes.
  
  
  
  A deprescribing self-efficacy survey was developed and administered to physicians, nurse practitioners and pharmacists at 3 long-term care (LTC) and 3 Family Health Teams in Ottawa, Canada at baseline and approximately 6 months after sequential implementation of each guideline. For each drug class, overall and domain-specific self-efficacy mean scores were calculated. The effects of implementation of each guideline on self-efficacy were tested by estimating the difference in scores using paired t-test. A linear mixed-effects model was used to investigate change over time and over practice sites.
  
  
  
  Of eligible clinicians, 25, 21, 18 and 13 completed the first, second, third and fourth survey respectively. Paired t-tests compared 14 participants for PPI and BZRA, and 9 for AP. Overall self-efficacy score increased for AP only (95% confidence intervals (CI) 0.32 to 19.79). Scores for domain 2 (develop a plan to deprescribe) increased for PPI (95% CI 0.52 to 24.12) and AP guidelines (95% CI 2.46 to 18.11); scores for domain 3 (implement the plan for deprescribing) increased for the PPI guideline (95% CI 0.55 to 14.24). Longitudinal analysis showed an increase in non-class specific scores, with a more profound effect for clinicians in LTC where guidelines were routinely used.
  
  
  
  Implementation of evidence-based deprescribing guidelines appears to increase clinicians' self-efficacy in developing and implementing a deprescribing plan for specific drug classes.
authors.affiliation: Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada; School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario N2G 1C5, Canada. Electronic address: bfarrell@bruyere.org.
authors.forename: Barbara
authors.initials: B
authors.lastname: Farrell
authors.affiliation: Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada; School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario N2G 1C5, Canada. Electronic address: lisa.sunstrum23@gmail.com.
authors.forename: Lisa
authors.initials: L
authors.lastname: Richardson
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada. Electronic address: l.raman.wilms.a@utoronto.ca.
authors.forename: Lalitha
authors.initials: L
authors.lastname: Raman-Wilms
authors.affiliation: Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada; School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, Ontario K1N 6N5, Canada. Electronic address: ddela032@uottawa.ca.
authors.forename: David
authors.initials: D
authors.lastname: de Launay
authors.affiliation: School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario N2G 1C5, Canada. Electronic address: wasem.alsabbagh@uwaterloo.ca.
authors.forename: Mhd Wasem
authors.initials: MW
authors.lastname: Alsabbagh
authors.affiliation: Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada; Department of Applied Human Sciences, Concordia University, 1455 de Maisonneuve Blvd. West, Montreal, Quebec H3G 1M8, Canada. Electronic address: james.conklin@concordia.ca.
authors.forename: James
authors.initials: J
authors.lastname: Conklin
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000069340:Deprescriptions; D055317:Evidence-Based Practice; D005260:Female; D058785:GABA-A Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D009864:Ontario; D010595:Pharmacists / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D020377:Self Efficacy
chemical_list: D014150:Antipsychotic Agents; D058785:GABA-A Receptor Agonists; D054328:Proton Pump Inhibitors
keywords: Deprescribing; Family health team; Guidelines; Long-term care; Polypharmacy; Self-efficacy