Barriers to and facilitators of deprescribing for older people in secondary care in Saudi Arabia: a qualitative study using a theory-based approach.

backgroundIn Saudi Arabia, over 55% of older people are exposed to potentially inappropriate medications. Deprescribing, a structured process to identify and discontinue unnecessary or harmful medications under medical supervision, by healthcare professionals (physicians and pharmacists) remains limited. Understanding barriers to and facilitators of deprescribing for older people from the perspectives of these healthcare professionals is essential for developing effective hospital-based deprescribing interventions.

methodsSemi-structured interviews were conducted with physicians and pharmacists working in hospitals in southern Saudi Arabia, recruited through purposive sampling. Eligible participants were physicians who worked with older inpatients and pharmacists with a ward-based role who had input into prescribing decisions. Theoretical Domains Framework (TDF2)-based interviews were conducted until data saturation was achieved. Inductive reflexive thematic analysis was first performed to generate themes from the data. Themes representing barriers and facilitators were then deductively mapped to TDF2 domains to prioritise domains and identify relevant behaviour change techniques (BCTs).

resultsTwenty physicians and 20 pharmacists were interviewed. Six prioritised TDF2 domains represented determinants for deprescribing: Social/professional role and identity, Social influences, Environmental context and resources, Knowledge, Behavioural regulation, and Beliefs about consequences. Key barriers included pharmacists’ limited role, clinicians’ perceptions of negative patient and carer attitudes toward deprescribing, concerns about negative outcomes, lack of guidelines and documentation, and resource constraints. Facilitators included inter-professional support, clinician education, and recognition of deprescribing benefits. Forty BCTs were identified for inclusion in a deprescribing intervention.

conclusionThis study provides a foundation for designing a theory-informed intervention to enable deprescribing in Saudi hospital settings. It highlights context-specific influences, including the need to enhance coordination across care levels and improve systemic supports for deprescribing.