{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T11:52:43Z","timestamp":1793447563565,"version":"4.5.0"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T00:00:00Z","timestamp":1581033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["167509"],"award-info":[{"award-number":["167509"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents\u2019 and relatives\u2019 fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients\u2019 health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient\u2019s wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team.<\/jats:p>","DOI":"10.3390\/pharmacy8010017","type":"journal-article","created":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T11:50:28Z","timestamp":1581076228000},"page":"17","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Physicians\u2019, Nurses\u2019 and Pharmacists\u2019 Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5928-2928","authenticated-orcid":false,"given":"Rose-Anna","family":"Foley","sequence":"first","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, 1011 Lausanne, Switzerland"},{"name":"School of Health Sciences (HESAV), University of Applied sciences and Arts, Western Switzerland (HES-SO), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie Lechevalier","family":"Hurard","sequence":"additional","affiliation":[{"name":"School of Health Sciences (HESAV), University of Applied sciences and Arts, Western Switzerland (HES-SO), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6540-9160","authenticated-orcid":false,"given":"Damien","family":"Cateau","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, 1011 Lausanne, Switzerland"},{"name":"Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria","family":"Koutaissoff","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Bugnon","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, 1011 Lausanne, Switzerland"},{"name":"Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8643-5731","authenticated-orcid":false,"given":"Anne","family":"Niquille","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, 1011 Lausanne, Switzerland"},{"name":"Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1093\/gerona\/glr233","article-title":"Polypharmacy in nursing home in Europe: Results from the SHELTER study","volume":"67","author":"Onder","year":"2012","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_2","first-page":"w20126","article-title":"Drug prescription patterns, polypharmacy and potentially inappropriate medication in Swiss nursing homes: A descriptive analysis based on claims data","volume":"149","author":"Schneider","year":"2019","journal-title":"Swiss Med. Wkly."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.jamda.2018.11.028","article-title":"Number of Medications and Mortality Among Residents in Nursing Homes","volume":"20","author":"Ruigomez","year":"2019","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"862.e1","DOI":"10.1016\/j.jamda.2016.06.011","article-title":"Prevalence of Potentially Inappropriate Medication Use in Older Adults Living in Nursing Homes: A Systematic Review","volume":"17","author":"Morin","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Nyborg, G., Brekke, M., Straand, J., Gjelstad, S., and Rom\u00f8ren, M. (2017). Potentially inappropriate medication use in nursing homes: An observational study using the NORGEP-NH criteria. BMC Geriatr., 17.","DOI":"10.1186\/s12877-017-0608-z"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1345\/aph.1E230","article-title":"Adverse outcomes associated with inappropriate drug use in nursing homes","volume":"39","author":"Perri","year":"2005","journal-title":"Ann. Pharmacother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.jclinepi.2012.02.018","article-title":"Polypharmacy cutoff and outcomes: Five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes","volume":"65","author":"Gnjidic","year":"2012","journal-title":"J. Clin. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1007\/s00520-015-2970-8","article-title":"Polypharmacy cut-points in older people with cancer: How many medications are too many?","volume":"24","author":"Turner","year":"2016","journal-title":"Support. Care Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1001\/archinte.165.1.68","article-title":"Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents","volume":"165","author":"Lau","year":"2005","journal-title":"Arch. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1111\/bcp.12732","article-title":"A systematic review of the emerging definition of \u2018deprescribing\u2019 with network analysis: Implications for future research and clinical practice","volume":"80","author":"Reeve","year":"2015","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"609","DOI":"10.7326\/M16-2729","article-title":"Discontinuing Inappropriate Medication Use in Nursing Home Residents: A Cluster Randomized Controlled Trial","volume":"167","author":"Wouters","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/bcp.12975","article-title":"The feasibility and the effect of deprescribing in older adults on mortality and health: A systematic review","volume":"82","author":"Page","year":"2016","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejim.2016.12.021","article-title":"Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action","volume":"38","author":"Reeve","year":"2017","journal-title":"Eur. J. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Palagyi, A., Keay, L., Harper, J., Potter, J., and Lindley, R.I. (2016). Barricades and brickwalls\u2014A qualitative study exploring perceptions of medication use and deprescribing in long-term care. BMC Geriatr., 16.","DOI":"10.1186\/s12877-016-0181-x"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"a1655","DOI":"10.1136\/bmj.a1655","article-title":"Developing and evaluating complex interventions: The new Medical Research Council guidance","volume":"337","author":"Craig","year":"2008","journal-title":"Br. Med. J."},{"key":"ref_16","unstructured":"Smart Health Care National Research Programme (2020, February 03). Project 06 Optimising the Medication of Elderly Persons Living in Nursing Homes. Available online: http:\/\/www.nfp74.ch\/en\/projets\/soins-stationnaires\/projet-bugnon."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jamda.2019.05.016","article-title":"Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities","volume":"21","author":"Niquille","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s11096-008-9273-9","article-title":"Development of pharmaceutical care services in nursing homes: Practice and research in a Swiss canton","volume":"31","author":"Locca","year":"2009","journal-title":"Pharm. World Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/jep.12741","article-title":"The struggle of translating science into action: Foundational concepts of implementation science","volume":"24","author":"Rapport","year":"2018","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1345\/aph.1M537","article-title":"The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles","volume":"44","author":"Niquille","year":"2010","journal-title":"Ann. Pharmacother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1080\/13645579.2017.1281601","article-title":"Comparing focus groups and individual interviews: Findings from a randomized study","volume":"20","author":"Guest","year":"2017","journal-title":"Int. J. Soc. Res. Methodol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/nur.20362","article-title":"What\u2019s in a name? Qualitative description revisited","volume":"33","author":"Sandelowski","year":"2010","journal-title":"Res. Nurs. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1177\/1060028016637181","article-title":"Deprescribing Potentially Inappropriate Preventive Cardiovascular Medication: Barriers and Enablers for Patients and General Practitioners","volume":"50","author":"Luymes","year":"2016","journal-title":"Ann. Pharmacother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1001\/jamainternmed.2018.4720","article-title":"Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States","volume":"178","author":"Reeve","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"ref_26","first-page":"171","article-title":"Points de vue d\u2019usagers sur la d\u00e9prescription de m\u00e9dicaments en maison de retraite","volume":"42","author":"Hurard","year":"2020","journal-title":"Gerontol. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.sapharm.2015.12.004","article-title":"Are residents of aged care facilities willing to have their medications deprescribed?","volume":"12","author":"Kalogianis","year":"2016","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.jamda.2018.10.026","article-title":"Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis","volume":"20","author":"Kua","year":"2018","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"i2893","DOI":"10.1136\/bmj.i2893","article-title":"Too much medicine in older people? Deprescribing through shared decision making","volume":"353","author":"Jansen","year":"2016","journal-title":"Br. Med. J."},{"key":"ref_30","unstructured":"(2019, January 24). Canadian Deprescribing Network, deprescribing.org. Available online: www.deprescribing.org."},{"key":"ref_31","unstructured":"Goffman, E. (1968). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, AldineTransaction."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e009781","DOI":"10.1136\/bmjopen-2015-009781","article-title":"What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals","volume":"6","author":"Turner","year":"2016","journal-title":"BMJ Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1136\/ejhpharm-2016-000900","article-title":"Impact of medication review, within a shared decision-making framework, on deprescribing in people living in care homes","volume":"24","author":"Baqir","year":"2016","journal-title":"Eur. J. Hosp. Pharm."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Abbott, A. (1988). The System of Professions: An Essay on the Division of Expert Labor, University of Chicago Press.","DOI":"10.7208\/chicago\/9780226189666.001.0001"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/bcp.13861","article-title":"Health care professionals\u2019 attitudes towards deprescribing in older patients with limited life expectancy: A systematic review","volume":"85","author":"Lundby","year":"2019","journal-title":"Br. J. Clin. Pharmacol."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/8\/1\/17\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:55:34Z","timestamp":1760172934000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/8\/1\/17"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,7]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["pharmacy8010017"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy8010017","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,7]]}}}