Primary care physicians’ preferences for implementation strategies of deprescribing among patients with multimorbidity and polypharmacy in China: a qualitative study

Xia et al. BMC Primary Care (2025) 26:350 https://doi.org/10.1186/s12875-025-03047-x BMC Primary Care Open Access RESEARCH Primary care physicians’ preferences for implementation strategies of deprescribing among patients with multimorbidity and polypharmacy in China: a qualitative study Yu Xia1†, Leyi Jiang2†, Ming Yan3, Liping Chen4, Xinmei Zhou2, Lingyan Wu2, Yi Guo2 and Zhijie Xu2* Abstract Background Although deprescribing is an evidence-based practice to address polypharmacy in patients with multimorbidity, primary care physicians (PCPs) face multiple challenges in its implementation. Designing implementation strategies to support PCPs in proactively deprescribing is necessary. However, little is known about PCPs’ preferences regarding such strategies. This study aimed to explore the preferences of PCPs in China for implementation strategies that facilitate deprescribing to enhance their acceptability and potential for uptake. Methods A qualitative study was conducted through semi-structured interviews with PCPs from 13 primary healthcare institutions (9 community health centers and 4 township health centers) in Zhejiang and Guangdong Provinces, China, from January 30 to March 15, 2025. Participants were purposively sampled using a maximum variation strategy. Data were analyzed thematically by two independent researchers. Results Twenty PCPs participated in the interviews, with a mean age of 34 years, and 14 (70%) were female. Preferences for implementation strategies centered around three themes: development of training program, provision of prescribing feedback, and prescribing quality assessment and incentives. Training programs were preferred to be practical, clinically relevant, and immediately applicable, with emphasis on case-based learning over theoretical lectures. Participants emphasized the importance of integrated prescribing feedback from credible sources, particularly experienced health professionals familiar with primary care workflows. A multi-level feedback framework was preferred, incorporating both peer feedback from trained colleagues within primary care settings and external quality assessments for objectivity and benchmarking against evidence-based standards. Conclusions Facilitating deprescribing among PCPs caring for patients with multimorbidity and polypharmacy requires integrated implementation strategies focusing on training program, feedback, and assessment and † Yu Xia and Leyi Jiang contributed equally to this work. *Correspondence: Zhijie Xu Full list of author information is available at the end of the article © The Author(s) 2025. 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To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Xia et al. BMC Primary Care (2025) 26:350 Page 2 of 10 incentives. Future research should develop and pilot test tailored strategies to evaluate their effectiveness, efficiency, and cost. Keywords Deprescribing, Multimorbidity, Polypharmacy, Primary care, Implementation strategies, Qualitative study Introduction Multimorbidity, defined as the coexistence of two or more chronic conditions in an individual, represents a significant global public health challenge, affecting approximately 33% of adults worldwide [1, 2]. In China, the prevalence of multimorbidity among adults is approximately 25%, and this rate increases rapidly with age—with 50.5% of individuals aged 60 years or older affected. The rapid progression of population aging is the primary driver behind this trend [3, 4]. Patients with multimorbidity frequently experience polypharmacy (i.e., the concurrent use of five or more medications), which substantially increases their risks of adverse drug reactions, drug-drug interactions, medication errors, and decreased medication adherence [5, 6]. Polypharmacy has emerged as a growing concern in China’s primary care system, with approximately 30% of older adults at primary care settings reporting polypharmacy use. This issue further exacerbates healthcare-related challenges amid China’s aging society [7]. The clinical and economic burden is considerable, with healthcare expenditures being twice as high as those for patients with a single condition and more than five times higher than for patients without documented chronic conditions [8]. Furthermore, polypharmacy significantly compromises patients’ quality of life, with studies demonstrating reduced health-related quality of life among older patients managing multiple medications [9]. Deprescribing is the systematic process of the planned and supervised cessation or dose reduction of medications. It has been recognized as an evidence-based practice (EBP) to address polypharmacy [10]. The process involves reviewing all current medications, identifying those to be discontinued, substituted, or reduced, developing a deprescribing plan in collaboration with the patient, and continuously monitoring and supporting the patient throughout the process [11]. Randomized controlled trials have shown that deprescribing interventions can significantly reduce the number of potentially inappropriate medications (PIMs) in older patients [12]. Moreover, clinical studies have demonstrated that appropriate deprescribing can reduce adverse drug events, improve medication adherence, and lower medication costs without compromising clinical outcomes [13]. Despite its proven benefits, deprescribing remains underutilized in clinical practice, particularly in primary care settings, where the majority of patients with multimorbidity receive ongoing care [14]. Primary care physicians (PCPs) are uniquely positioned to manage the complex medication regimens of patients with multimorbidity due to their continuous, comprehensive, and person-centered approach to care [15]. Their long-term relationships with patients allow them to understand individual treatment goals and preferences, making them well-suited to initiate and monitor deprescribing interventions. However, implementing deprescribing in routine practice is fraught with challenges. Our previous study highl (...truncated)