Reasons Behind Continuity of In-Hospital Deprescribing Post Discharge: A Qualitative Study

OBJECTIVES: Deprescribing reduces inappropriate polypharmacy in older adults and may be initiated in hospital. However, deprescribing changes initiated during a hospital admission are not always continued post discharge and deprescribing recommendations for inpatients to implement post discharge are not always actioned. This study aimed to explore reasons behind continuity of hospital-initiated deprescribing and actioning of hospital deprescribing recommendations post discharge from the perspectives of older adults/carers and health care professionals. DESIGN: A qualitative observational study. SETTING AND PARTICIPANTS: Australian tertiary metropolitan hospital. Patients aged ≥65 years with deprescribing commenced in hospital or recommended for actioning post discharge, or their carers were eligible. Hospital clinicians and community pharmacists caring for consenting patients were also eligible. METHODS: Hospital clinicians were interviewed before discharge. One month post discharge, patients were interviewed, and patients' community pharmacists were sent a survey. Interview transcripts underwent inductive and deductive thematic analysis. RESULTS: Nineteen patients/carers and 19 hospital clinicians were interviewed. Thirteen community pharmacists completed the survey. Most patients were women (68%) with a median age of 84 years (interquartile range, 79-93). One month post discharge, most patients had all deprescribing decisions continued (n = 11 of 13 with in-hospital deprescribing, 85%) or all recommendations actioned (n = 11 of 14 with deprescribing recommendations, 79%). Three key themes arose from all stakeholders' responses: (1) acceptance of deprescribing by patients and usual care providers, (2) comprehension of the deprescribing plan, and (3) supportive post-discharge environment. CONCLUSIONS AND IMPLICATIONS: Stakeholders reported factors affecting deprescribing continuity and actioning, from hospital admission to the post-discharge setting. These findings can guide the codesign of future interventions that support deprescribing continuity and actioning of deprescribing post discharge.