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.