Barriers to appropriate prescribing in older adults with multimorbidity: A modified Delphi study

• Published in: Aging medicine Vol. 4; no. 3; pp. 180 - 192
• Main Authors: Lun, Penny, Tang, Jia Ying, Lee, Jia Qi, Tan, Keng Teng, Ang, Wendy, Ding, Yew Yoong
• Format: Journal Article
• Language: English
• Published: Australia John Wiley & Sons, Inc 01.09.2021; John Wiley and Sons Inc; Wiley
• Subjects: aged; Agreements; ambulatory care; Clinical medicine; Cognitive ability; Comorbidity; Delphi method; Geriatrics; Intervention; multimorbidity; Older people; Original; Polypharmacy; practice patterns (physicians’); Questionnaires; Trends; Singapore; aged; multimorbidity; ambulatory care; practice patterns (physicians’); polypharmacy
• ISSN: 2475-0360; 2475-0360
• DOI: 10.1002/agm2.12169

Objectives We aimed to understand the barriers experienced by physicians when prescribing for older adults with multimorbidity in specialist outpatient clinics in Singapore. Methods A modified Delphi study was conducted via email with 20 panel experts in the field of geriatric medicine. Barriers identified from an earlier scoping review were presented as statements to the panel. Results Eleven barrier statements reached consensus with high importance according to the Delphi panel. Of these statements, seven (64%) belong to the domain of Environmental context and resources in the Theoretical Domains Framework (TDF), while the remaining barriers belong to the domains of skills, knowledge, intentions, and professional/social role and identity. The barriers are further linked to intervention functions in the Behaviour Change Wheel (BCW). Conclusion Linking the TDF domains to intervention functions revealed strategic directions for the development of an intervention to address the barriers and optimize prescribing. Eleven barrier statements reached consensus with high importance according to the Delphi panel. Linking the barriers to Theoretical Domains Framework and intervention functions revealed strategic directions for the development of an intervention to address the barriers and optimize prescribing.