Digital support tool for deprescribing psychotropics in general practice - applicability and feasibility from general practitioners’ perspectives

Kerstin Bernartz, Stephanie Picker-Huchzermeyer, Svenja Claaßen, Prashamsa Chapidi, Kiran Chapidi, Tobias Dreischulte, Annette Härdtlein, Vita Brisnik, Achim Mortsiefer, Sophie Peter, Michaela Maas, Hanna Seidling, Laura Lepenies, Mark Horowitz, Christiane Muth, Svetlana Puzhko

Keywords: Psychotropic drugs, Deprescribing, Digital tool

Background:

Deprescribing psychotropic medications is challenging for general practitioners (GPs). Digital tools can assist in selecting appropriate tapering regimens that may reduce withdrawal symptoms and enhance patient motivation. The ‘Tapering Support Tool’, developed as part of a deprescribing study, includes evidence-based recommendations to optimize tapering regimens and management of withdrawal symptoms. It calculates 'hyperbolic tapering' to achieve a linear decrease in receptor occupancy, potentially alleviating withdrawal symptoms.

Research questions:

How do GPs perceive the usefulness, functionality, and content of the Tapering Support Tool in clinical practice, and what are their suggestions for improving its integration into routine workflows?

Method:

A qualitative study is planned involving semi-structured interviews with a maximum variation sample of GPs (n=10), differing in age, gender, professional experience, and practice location. Interviews with four GPs have already been conducted. The questions address usefulness in clinical practice, functionality, and content. The transcripts were thematically analyzed by two independent researchers, employing both inductive and deductive approaches as described by Braun and Clarke, using MAXQDA software.

Results:

Initial interviews with four GPs revealed the need for a digital tool to support the almost daily deprescribing of psychotropic medications. The tool was well-received for its usability, functionality, and practicality. Participants noted its potential to enhance patient communication and optimize planning. For most, it was their first exposure to hyperbolic tapering. Suggestions included adding graphical tapering schedules and direct patient-facing features to improve communication and optimize clinicians' time. A key concern was the practical implementation of hyperbolic tapering at low doses.

Conclusions:

GPs rated the tool as user-friendly, functional, and practical, noting its potential to support shared decision-making with patients. Initial modifications were made based on their suggestions for improvement. Incorporating the tool into GPs' daily routines can facilitate the effective deprescribing of psychotropic medication.

Points for discussion:

Barriers and Challenges in Deprescribing: What are the key barriers GPs face in tapering psychotropic medications, including managing withdrawal symptoms and patient motivation? How can these be addressed to improve the deprescribing process?

Role of Digital Tools in Deprescribing: How can digital tools like the Tapering Support Tool enhance shared decision-making, and what strategies can ensure their successful integration into daily practice, particularly for implementing hyperbolic tapering schemes?

Support for Tool Adoption: What role can health systems or policymakers play in supporting the adoption and effective use of deprescribing tools in general practice, including addressing challenges in small dose reductions?

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