Background: Collaborative care approaches between general practitioners (GPs) and pharmacists have received international recognition for medication optimisation and deprescribing efforts. Although even specialist providers have been shown to influence deprescribing, their profession so far remains omitted from collaborative care approaches for medication optimisation. Similarly, while explorative studies on role perception and collaboration between GPs and pharmacists grow, interaction with specialists for medication optimisation is neglected. Our qualitative study therefore aims to explore GPs`, community pharmacists` and specialist providers` role perceptions of deprescribing, and to identify interpersonal as well as structural factors that may influence collaborative medication optimisation approaches.
Method: Seven focus-group discussions with GPs, community pharmacists and community specialists were conducted in Hesse and Lower Saxony, Germany. The topic guide focused on views and experiences with deprescribing with special attention to inter-professional cooperation. We used conventional content analysis following an inductive-deductive approach.
Results: Our exploration of role perceptions revealed factors influencing deprescribing collaboration on both interpersonal and structural levels. On interpersonal level, conflicting role positions exposed in clashes of perceived authority, while conflicting role functions were indicated by disagreement on responsibility for deprescribing tasks between stakeholder groups, and resulted in underutilisation of services. Lacking communication was reported as a general barrier to cooperation. On a structural level, missing transparency on medication information across providers and deficient reimbursement for medication optimisation activities emerged as most pronounced obstacles for successful collaborative deprescribing. Also, unclear definition of task division between professional groups provoked difficulties.
Conclusion: Revealing relevant stakeholders` role perceptions on their responsibilities and delimitations for joint deprescribing is a prerequisite for collaborative care approaches. Our study revealed several preconditions for joint deprescribing action that emerge from the German setting, but may as well inform other health-systems. As such, necessary medication transparency may be enabled by sector-wide electronic health records. For clarification of role definitions, joint training sessions across stakeholder groups may strengthen future cooperation. Finally, even redefining professional roles should be considered to strengthen GPs` regulatory functions and promote a continuity of care.