Barriers and facilitators to deprescribing in primary care in Brazil: a qualitative study of pharmacists’ perspectives mapped to the Theoretical Domains Framework

Abstract

Objective: To identify the main Barriers and facilitators to deprescribing from the perspective of primary care pharmacists in Brazil. Methods: In this qualitative secondary analysis, we analyzed brief written responses collected during a training session on medication deprescribing. Data were elicited through a SWOT (Strengths, Weaknesses, Opportunities, and Threats)-based structured activity and analyzed using qualitative content analysis. Emerging categories were subsequently interpreted through the Theoretical Domains Framework. Results: Responses were categorized into barriers (related to healthcare professionals, service structure, patients, and the healthcare model) and facilitators (advances in evidence, benefits of deprescribing, availability of resources, management support, and favorable attitudes among professionals and patients). These categories were mapped to Theoretical Domains Framework domains, including Beliefs about Consequences, Environmental Context and Resources, Social Influences, and Social/Professional Role and Identity. Conclusion: Implementing deprescribing in Brazil faces challenges but prospects are also promising. Adopting interprofessional approaches, educating patients, involving management, and investing in resources to strengthen primary health care are essential to optimize clinical outcomes and reduce health-related costs.