Introduction
The use of five or more medications can be considered as polypharmacy.
Polypharmacy is mostly associated with adverse drug events (ADEs),
leading to heightened morbidity, mortality, and healthcare cost (1-3).
ADEs due to polypharmacy are prevailing and occur in approximately 25%
of outpatients (3).
Medication discontinuation or deprescribing is one of the interventions
to reduce inappropriate polypharmacy and its associated ADEs. It is a
process of detecting and stopping medications when the actual or
potential harms exceed the actual or potential benefits taking into
consideration a variety of factors including the individual patient’s
therapeutic care plans, level of functioning and needs (4, 5).
Discontinuation of inappropriate polypharmacy has several benefits to
the patient, such as reducing costs associated with medicines and their
ADEs, improving adherence, and overall quality of life (6). This is
especially true in developing countries including Ethiopia, where the
primary source of drug expenditure is patients’ out of pocket money, and
a significant percentage of the population purchase medicines from
private drug retail outlets (7).
In addition to the economic implication associated with the prescription
of multiple medications, polypharmacy is becoming common, resulting in
ADEs in Ethiopia (8). This problem is more pronounced in older Ethiopian
patients leading to poor quality of life due to polypharmacy (9).
Fortunately, Ethiopian older patients seem to be willing and cooperative
to discontinue one or more of their medications as long as their doctors
said it was possible. This could potentially facilitate decision making
for healthcare providers (HCPs) during the deprescribing process (10).
Unlike medication adherence and medication reconciliation, the concept
of deprescribing receive little attention in literature worldwide (11).
Though HCPs are keen on deprescribing in developed countries (12),
factors like clinical uncertainty and multidisciplinary shared
responsibility, could severely hamper their ability to proactivity
deprescribe (13). However, data on the perception of physicians,
clinical pharmacists, and nursing practitioners regarding proactive
medication discontinuation and lessening of inappropriate polypharmacy
are lacking in the developing and resource-limited countries, including
Ethiopia. Hence, we undertook the present institutional-based survey to
document the experiences, attitudes, and beliefs of HCPs toward
intentional medication discontinuation.