Table 2 Beliefs forming a General Practitioner’s intention to deprescribe

1. Self-efficacy

I deprescribe

“I cease Warfarin [for] all my nursing home patients without exception because I think it’s actively dangerous to be on Warfarin.” (AusGP4)

“As soon as a problem arises, I take a look at the medication list and figure out which one to deprescribe.” (SweGP10)

Insecurity

“Say someone was [on] Parkinsonism drugs - I would be less confident stopping it because… I do initiate anti-Parkinsonism drugs, but not at the higher end of them.” (AusGP6)

“And where it can be hard to gain support for examinations and follow-ups and help with observations and so… they like to call for sedatives, when instead there is a need of attendance and measures other than medications.” (SweGP10)

Evidence and know-how

“From a University point of view, if you could train the undergraduate to be interested in coming to the nursing home. This is the greatest point…” (AusGP8)

“I have only had one course on elderly and medications, and that was long ago. But I still use the notes from that class.” (SweGP1)

“Is it right or wrong to deprescribe this medication? You are pretty alone in the decision actually. I would like some kind of mentorship or someone to talk to.” (SweGP3)

2. Norms

Unrealistic expectations

“And, I think, sometimes the specialists are a bit unrealistic. Sometimes they’re a little bit unrealistic about what’s actually going on - on the actual coalface, I think.” (AusGP4)

“I don’t think they need some of the medications, but it is all psychology, the psychology of the patient and of the staff. They believe somehow that somethings would get better with pills.” (SweGP5)

The Almighty doctor

“So they’re [relative] feeling guilty about the fact that they’ve [their parent] gone into the nursing home…So the…family want them to keep on going and going and going, so you do everything possible to keep them [resident] alive.” (AusGP6)

“There is a focus on the doctor. And I have very little chance to help the patient because what the patient actually is in need of is basic care …but this may lead to that a patient gets many medications” (SweGP11)

3. Attitudes

Facilitating a good quality of life

“I think the medications which keep them comfortable are important, like pain medications can help them. And those ones which are related to heart.” (AusGP5)

“…the first priority is definitely to reduce suffering, reduce anxiety…try to make life meaningful for the patient. Diseases are secondary.” (SweGP4)

Interest and disinterest in aged care

“I think that’s a big barrier for us to be able to get other doctors [to] actually provide services there [in the aged care facility].” (AusGP6)

“It [aged care work] is sort of a relief compared to the ordinary work at the primary health care centre, you get away from the primary health care centre for a while every week and it is freer time, not the scheduled appointments all the time, but you go there and sometimes you visit the patients and sometimes you just discuss the patients. It is more free and a different way of working with patients.” (SweGP12)