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Table 3 Barriers to following the recommendations from the GPs’ point of view

From: Reduction of inappropriate medication in older populations by electronic decision support (the PRIMA-eDS study): a qualitative study of practical implementation in primary care

Reasons for not following the recommendations Quotes
Alternatives and recommendations had already been tested and the GP and/or the patient felt that this was not the optimal way of treatment. It's a long way making that decision and once it’s made and then it is an important drug. I don’t care if there is a contraindication, he’ll get it nevertheless. (GP 19)
Why in this patient I won’t follow the recommendations is that it has already been tried out in the past. (GP 3)
The GP regarded the medication as being necessary. Out of the multimorbidity of the people, it is inevitable that one gives them [the drug]. (GP 6)
The GP and/or the patient had other priorities compared to the PRIMA-eDS tool. Then the patient decides for me. From a certain age on it is about the quality of life. (GP 10)
Concerning diclofenac for the older patients it simply is like that, he just doesn’t want [to discontinue the drug] and says, “you can’t take this away from me. [I am] free of pain for the first time in 7 years. I need that.” (GP 10)
The GP feared that changing medication could get complex. In case of a patient for whom this medication works so well, in inverted commas, over such a long period of time I won’t change anything. This would just rock the boat. (GP 3)
The GP had been prescribing the medication for years and lacked motivation to reconsider. And that is simply a drug that the patient is using for 30 years now and under which she is well managed concerning her blood levels. [And] as mentioned leading a life with very little hardship with over 90 years. I would not touch it, that is [a case of] ‘never change a winning team’, therefore these are things I wouldn’t change. (GP 12)
The GP did not want to diverge too far from a standard of therapy (guidelines). So you have to ultimately stick to the general guidelines, because if you go there now radically, then you contravened the guidelines of the professional societies. It’s difficult. (GP 9)
The GP found the recommendation to be new and not comprehensible. I’ve never heard that before, it somehow was completely new to me and so I ignored it. (GP 16)
The GP considered the recommendation as not applicable to the individual patient. Where I say that the patient is biologically younger. (GP 1)
The GP found that the patient was a barrier to discontinue medications. The patient won’t cooperate. If there wasn’t the patient, everything would be easier. (GP 15)
The prescription was made by another medical specialist and the GP did not want/ did not dare to change it. Who is responsible for which prescription. The things I do not prescribe, the four medications I do not prescribe, the four psychotropic drugs, I can’t change that. (GP 7)
It seems that due to the infrastructure medication changes resulting from the CMR could have been delayed or even forgotten. This actually is a relatively long process, as I don’t have internet access here. […] I print it [the CMR] and make notes. […] Then I wait until the patient comes again. But I have [a study patient] who doesn’t come very often and then it's difficult. (GP 2)