Table 1 The domain of professional role and identity

GPs are the central medication managers (GP, CS, CP)

1

Facilitator 1: How is it in general, who is responsible for medication? The GPs, or the specialists? GP25F: We are. The GPs.

2

CS33M: (...) all that usually is transferred to the central manager of the patient, the GP, who should check the medication.

3

CS32M: In my understanding, the GP basically has the management supremacy. There is no other way. In a time when specialist groups become smaller and smaller and more and more specialized, where always more single medications emerge, these ´blinkered specialists` are no longer able to know what’s really necessary.

4

CP21M: That’s why you, the GP, act as an interface – not the specialist. Because the latter only sees his own specialty. The ophthalmologist considers eye drops for glaucoma. But he doesn’t take note of what else is done. And that’s why I really think that the GP is just the right interface. And that’s I think the most important link in this position.

5

CS32M: For example, is a heart failure therapy that the cardiologist has administered out of his own ambition really the optimal solution? Or is it rather necessary to keep the patient free of pain? And for individual specialists, of course, all this is hard to judge. In fact, it’s partially up to the GP or the internist to consider what’s actually best for this patient, here and now.

CSs’ role in deprescribing is well-defined and limited (CS, GP)

6

CS14M: I am totally responsible for a medication that I have prescribed, of course and on the basis of my knowledge -as far as I have some- for the other medications (…) But our policy is: repeat prescriptions, apart from a few exceptions, are made by the GP.

7

CS14M: I never deprescribe non-cardiologic medication independently without checking with the GP. (…) Because I as a specialist in case of doubt never will have as much information as the GP who knows his patient for 20 years.

CPs should act as supporting second-line force in deprescribing (CP, GP)

8

CP21M: I once had a patient who had received a prescription for haloperidol from his psychiatrist and increasing amounts of madopar from his neurologist. The reason is obvious, right? One doctor sedated him, the other fought the side effects. That’s a true classic. When we in the pharmacy see this, we of course have the duty to bring these two together.

9

CP12F: We have an obligation to give counsel and we must check interactions.

10

CP11F: It actually is our profession to explain to somebody what the doctor has prescribed. We shouldn’t talk him out of it.

11

CP21M: We don’t have the expertise. We can’t answer actual medical questions. We must not, too! We can’t. Because we haven’t studied it. We can’t make a diagnosis.

12

GP13M: The primary responsibility for polypharmacy and prescriptions actually lies with the doctors. And I need the pharmacists as second-line force, sort of. Because when I see a medical indication and prescribe an antidepressant but didn’t get that he already has QT-prolonging medication, then I need feedback, somebody who says: Stop! Do you know what you’re doing here? Then I receive a telefax. And I appreciate that.