To prescribe or not to prescribe in the elderly: a qualitative exploration of prescribing dilemmas among Pakistani healthcare providers

Abstract

Objective Potentially inappropriate prescribing is a global health issue with catastrophic consequences in the elderly population. Healthcare providers play a critical role in medication optimisation in elderly patients. The present study aims to explore the perceptions of healthcare professionals (prescribers) regarding the complexities of inappropriate prescribing practices in the elderly population. Design A qualitative study using semistructured interviews was conducted. All the data were transcribed verbatim and analysed via Braun and Clarke's thematic analysis approach. Setting Prescribers working in a tertiary care hospital in Karachi, Pakistan. Participants Prescribers having more than 5 years of experience in elderly prescribing. Participants were selected using purposive sampling, and recruitment continued until the point of data saturation, meaning no new major themes emerged. Results 13 prescribers, five females and eight males with an average experience of 15.3 years, were interviewed. The interviews lasted for an average of 15 min. The analysis revealed three primary themes: (1) inappropriate prescribing, characterised by knowledge and awareness of inappropriate prescribing and its assessment tools; (2) complexities in elderly prescribing, highlighting patient factors such as comorbidities, polypharmacy, psychological issues and socioeconomic challenges, as well as prescriber factors; and (3) interventions to improve prescribing, emphasising the role of pharmacists in enhancing medication safety, the importance of effective patient-prescriber relationships through counselling and the need for regulatory measures to monitor prescribing behaviours. Inadequate knowledge of standardised assessment tools such as the Screening Tool to Alert to Right Treatment/Screening Tool of Older Persons' Prescriptions criteria, time constraints faced by prescribers and fragmented healthcare systems were some of the barriers identified by the respondents in medication optimisation for elderly individuals. Conclusion The findings highlight the need for enhanced education on standardised assessment tools and the implementation of targeted interventions. A key recommendation is the integration of clinical pharmacists into care teams to optimise prescribing practices.