• Matthew E Growdon, Lauren J Hunt, Matthew J Miller, Madina Halim, Leah S Karliner, Ralph Gonzales, Rebecca L Sudore, Michael A Steinman, and Krista L Harrison.
• Division of Geriatrics, University of California, San Francisco, CA, USA. matthew.growdon@ucsf.edu.
• J Gen Intern Med. 2024 Oct 1; 39 (13): 246124702461-2470.

BackgroundElectronic consultations (eConsults) enable asynchronous consultation between primary care providers (PCPs) and specialists. eConsults have been used successfully to manage a variety of conditions and have the potential to help PCPs manage polypharmacy and promote deprescribing.ObjectiveTo elicit clinician perspectives on barriers/facilitators of using eConsults for deprescribing among older adults within a university health network.DesignSemi-structured interviews.ParticipantsPCPs, geriatricians, and pharmacists.ApproachWe used the COM-B (Capability, Opportunity, Motivation, and Behavior) model to structure the interview guide and qualitative analysis methods to identify barriers/facilitators of (1) deprescribing and (2) use of eConsults for deprescribing.Key ResultsOf 28 participants, 19 were PCPs (13 physicians, 4 residents, 2 nurse practitioners), 7 were geriatricians, and 2 were pharmacists. Barriers and facilitators to deprescribing: PCPs considered deprescribing important but identified myriad barriers (e.g., time constraints, fragmented clinical care, lack of pharmacist integration, and patient/family resistance). Use of eConsults for deprescribing: Both PCPs and geriatricians highlighted the limits of contextual information available through electronic health record (vs. face-to-face) to render specific and actionable eConsults (e.g., knowledge of prior deprescribing attempts). Participants from all groups expressed interest in a targeted process whereby eConsults could be offered for select patients based on key factors (e.g., polypharmacy or certain comorbidities) and accepted or declined by PCPs, with pithy recommendations delivered in a timely manner relative to patient appointments. This was encapsulated by one PCP: "they need to be crisp and to the point to be helpful, with specific suggestions of something that could be discontinued or switched…not, 'hey, did you know your patient is on over 12 medicines?'".ConclusionsClinicians identified multifaceted factors influencing the utility of eConsults for deprescribing among older adults in primary care. Deprescribing eConsult interventions should be timely, actionable, and mindful of limitations of electronic chart review.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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