Exploration of Perceptions of Deprescribing Practices Among Doctors in a Low- and Middle-Income Country: A Mixed-Methods Study

Abstract

With the increasing prevalence of potentially inappropriate medications in low- and middle-income countries (LMICs) like Nepal, the role of deprescribing is ever important. However, evidence on how Nepalese doctors perceive deprescribing in their practice is lacking. A sequential explanatory mixed-method study was conducted among 115 doctors at a tertiary-level teaching hospital in central Nepal using a structured questionnaire. Quantitative data from Likert-scale items were analysed descriptively, while thematically analysing open-ended responses. Only 45 doctors (39.1%) had heard of deprescribing, and 77.8% reported practising it. Most doctors (80%) understood the rationale behind each prescription, and 94.3% agreed on ensuring patient comprehension of prescribed medicines. Only 52.4% routinely involved patients in deprescribing decisions, and 31.4% acknowledged prescribing ‘too many drugs’ at times. Qualitative analysis identified three deprescribing-related themes: (1) general understanding: deprescribing viewed as a planned, systematic process to optimize treatment, minimize polypharmacy, reduce costs, and improve safety; (2) Enablers: patient factors, treatment considerations, medication issues, disease process, prescriber competencies and institutional support; (3) barriers: patient resistance, prescribing inertia, knowledge gaps, coordination issues, time constraints, cost and pharmaceutical influences. Doctors demonstrated a moderate understanding of deprescribing but faced several contextual challenges, highlighting the need for targeted education, institutional policies and deprescribing frameworks in LMICs.