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Table 3 The domain of reinforcement

From: Professional roles of general practitioners, community pharmacists and specialist providers in collaborative medication deprescribing - a qualitative study

Reinforcement to deprescribing activities and collaboration

Belief

(as expressed by professional group)

Quote No.

Quote and speaker (indicating professional group, participant ID and sex e.g. GP1M = General practitioner 1, male)

GPs are reprimanded for deprescribing actions (GP)

24

GP13M: The biggest problem for me is the contact with other specialists, especially cardiologists. When I deprescribe a 90-years old patient’s statin (…), the guy [cardiologist] rips me into shreds, this idiot GP who doesn’t know the first thing, deprescribing the statin! He could die from this AND get a heart attack and so on. Then it’s difficult. And when I know this I won’t deprescribe anything. Because, this scolding -I mean, I can take a lot. But at some point, I need to draw a line.

CP’s medication optimization efforts are not valued (CP, GP)

25

CP19F: In 80% of the cases, one is treated with disrespect for this kind of feedback [on interaction checks]. I had it only once in my career I heard a doctor saying ‘I appreciate your call.’ (…) Once! In 20 years!

 

26

GP10M: I receive a fax from the pharmacist every time something doesn’t fit together (…) this know-it-all fax: here, look, you’ve prescribed the wrong stuff together again (…) when you’ve thought it through and now there’s this fax …

 

27

GP13M: When I see a medical indication and prescribe an antidepressant but didn’t get that [the patient] 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.

 

28

GP17M: How do we manage all this without offending anybody? The pharmacist’s got the expertise, but the physician doesn’t want anybody to interfere.

 

29

GP4M: I’m not crazy about pharmacists, because it’s such a giant commerce. I don’t believe they represent my key contact for deprescribing strategies or such things, because they want to sell it [the medications].

 

30

CP12F: Every unit of medications less prescribed means for the pharmacist: Less sales. Our salary is measured by unit volume! Really! The better we consult, the more we cooperate with you, the less profit we make. In other words: we do the right thing, and we get less for it. And that’s our core problem!

  1. Legend: GP General practitioner, CP Community pharmacist, CS Community specialist