• Ellen Van Leeuwen, Sibyl Anthierens, Mieke L van Driel, De SutterAn I MAIMUnit General Practice Ghent University, Department of Public Health and Primary Care, Ghent University, Gent, Belgium., van den BrandenEvelienEUnit General Practice Ghent University, Department of Public Health and Primary Care, Ghent University, Gent, Belgium., and Thierry Christiaens.
• Clinical Pharmacology Unit, Department of Basic and Applied Medical Sciences, Ghent University, Gent, Belgium.
• Eur J Gen Pract. 2022 Dec 1; 28 (1): 23-31.

BackgroundLong-term use of antidepressant drugs (AD), much longer than recommended by guidelines, in nursing homes (NH) is common. NH home residents may have a relatively higher risk of adverse events. Moreover, in an NH setting nursing staff and relatives are intensively involved in the decision-making process. In many countries, General Practitioners' (GPs) provide care for residents in NHs. Little is known about GPs' perspectives on discontinuation of long-term AD in NH residents.ObjectivesTo explore GPs' views of discontinuing long-term AD in NH residents.MethodsAn exploratory qualitative study, with semi-structured interviews, was conducted with a purposive sample of 20 Belgian GPs. Interviews, conducted over six months in 2019, were analysed by thematic analysis.ResultsTwenty interviews were conducted until data saturation. The first theme, 'reluctance to rock the boat: not worth taking the risk', describes that GPs perceive discontinuation as an unpredictable risk without clear benefits. GPs' main concern was the risk of destabilising the fragile balance in an older patient. Second, 'it takes at least three to tango', captures the unspoken alliance between GPs, nursing staff and relatives and suggests that agreement of at least these three partners is required. The third, 'Opening the door: triggers to discontinue', points to severe health problems and dementia as strong facilitators for discontinuation.ConclusionDiscontinuation of long-term AD in NHs is a complex process for GPs. More evidence and attention to the role nursing staff and relatives play are needed to better guide the discontinuation of AD in older NH patients.

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