In recent years, the concept of deprescribing—systematically reducing or stopping medications that may no longer be beneficial or might be causing harm—has garnered significant attention in the medical community, especially concerning the elderly population. This topic is particularly relevant in the context of secondary care, where older patients often experience complex medication regimens. A groundbreaking qualitative study conducted in Saudi Arabia has now shed light on the multifaceted barriers and facilitators that influence deprescribing practices in this setting, offering novel insights that could transform geriatric healthcare globally.
Older adults frequently suffer from polypharmacy, which is the simultaneous use of multiple medications. This practice, while sometimes necessary, harbors substantial risks, such as adverse drug reactions, drug interactions, and reduced medication adherence. The study conducted by Alenzy, Barry, Alkahtani, and colleagues meticulously explores why deprescribing is not more commonly practiced in Saudi secondary care settings, despite its potential benefits in optimizing patient outcomes. Employing a theory-based qualitative approach, the research investigates healthcare professionals’ perspectives and the systemic factors at play.
One of the most striking revelations from the study is how healthcare professionals’ attitudes and beliefs strongly impact deprescribing decisions. The fear of negative outcomes, such as withdrawal effects or disease relapse, often creates reluctance among clinicians to de-escalate medications. This apprehension is compounded by a lack of confidence stemming from limited training in deprescribing protocols. The research elucidates how these psychological barriers contribute to overprescription and hesitation in reviewing patients’ polypharmacy profiles thoroughly.
A crucial systemic challenge identified involves communication gaps within healthcare teams and between secondary and primary care providers. The study highlights that inefficient communication pathways can hinder the sharing of vital information, thus delaying or obstructing deprescribing efforts. This issue is exacerbated in secondary care environments where multiple specialists may be involved in managing a single patient’s medications, leading to fragmented care and uncertainty about who holds responsibility for medication reviews.
Moreover, patient-related factors, including their preferences and understanding of medicines, are pivotal in the deprescribing process. The study reveals that older patients often have considerable trust in their medications and can be resistant to changes, especially when they lack adequate education about the risks and benefits of ongoing treatments. Cultural dimensions unique to Saudi Arabia, such as familial involvement in healthcare decisions, further complicate this dynamic and require tailored communication strategies to ensure patient-centered deprescribing.
The investigation also underscores the role of organizational frameworks and policy support in facilitating deprescribing. The absence of dedicated guidelines and standardized pathways in Saudi secondary care settings undermines systematic medication reviews. The research points to the necessity for implementing robust deprescribing frameworks that empower healthcare providers with clear protocols, encouraging consistent and safe medication discontinuation practices.
An encouraging finding is the potential for multidisciplinary collaboration to act as a facilitator of deprescribing. Pharmacists, nurses, and physicians, when working cohesively, can pool their expertise to identify inappropriate medications and develop individualized withdrawal plans. The study advocates for enhanced interprofessional education and team-based clinical decision-making models to harness this potential, which could significantly improve medication safety in older patients.
The study’s use of a theory-based qualitative methodology provides a rich, context-sensitive understanding of the factors influencing deprescribing. By grounding their research in established behavioral and implementation science frameworks, the authors map the cognitive, social, and structural elements that create barriers or act as facilitators. This approach not only adds rigor to the findings but also guides the design of targeted interventions to overcome existing challenges in deprescribing practices.
Technology adoption emerges as another critical facilitator. Electronic health records (EHRs) and clinical decision support systems (CDSS) equipped with deprescribing alerts and risk assessment tools can aid clinicians in identifying medication appropriateness. The study indicates that enhancing these digital resources within Saudi healthcare settings could streamline medication reviews and encourage proactive deprescribing.
Training and continuous professional development focused on deprescribing principles remain a pressing need. The research advocates for integrating deprescribing education into healthcare curricula and providing ongoing workshops and resources. Equipping healthcare workers with the knowledge and skills to conduct safe medication tapering will bolster their confidence and reduce fear-driven inertia in clinical practice.
Importantly, policy makers are called to action by the study’s outcomes. Developing national strategies that prioritize medication optimization for older adults, including funding for deprescribing initiatives and incentivizing best practices, could catalyze systemic change. Aligning policies with the World Health Organization’s goals of reducing polypharmacy-related harm would place Saudi Arabia at the forefront of geriatric pharmacotherapy reform.
While the study focuses on the Saudi Arabian context, its implications resonate worldwide, especially in societies facing rapidly aging populations and escalating medication burdens. The nuanced insights regarding cultural, organizational, and professional determinants of deprescribing could inform international efforts to enhance medication safety and health outcomes for older adults.
In conclusion, this comprehensive qualitative exploration provides a vital roadmap for advancing deprescribing in secondary care settings. By illuminating the complex interplay of barriers and facilitators, it paves the way for strategic interventions encompassing education, policy, multidisciplinary collaboration, and technology integration. The future of geriatric care hinges on such research, which champions safer, more rational medication practices tailored to the evolving needs of older patients.
Subject of Research: Barriers and facilitators influencing the practice of deprescribing for older adults in secondary care in Saudi Arabia.
Article Title: Barriers to and facilitators of deprescribing for older people in secondary care in Saudi Arabia: a qualitative study using a theory-based approach.
Article References:
Alenzy, T.M., Barry, H.E., Alkahtani, S.A., et al. Barriers to and facilitators of deprescribing for older people in secondary care in Saudi Arabia: a qualitative study using a theory-based approach. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07486-8
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