Exploring perceived barriers, facilitators, and team roles in addressing prescribing cascades in primary care teams: Insights from interprofessional focus groups

BACKGROUND: Prescribing cascades are common contributors to medication-related harm. Primary care clinicians who practice in interprofessional teams may be well positioned to address cascades in practice; although, the factors that influence their ability to do so in this particular setting are largely unknown. Our study aimed to explore perceived barriers and facilitators that influence the identification, investigation, and management of prescribing cascades as experienced by primary care teams and each profession's role in addressing cascades. METHODS: Physicians, nurse practitioners, and pharmacists practicing in primary care teams in Ontario, Canada participated in a series of intra-professional and interprofessional focus groups. The focus groups explored clinician perspectives about factors that influence their ability to address cascades. Discussion and analyses were guided by the Theoretical Domains Framework and the Behaviour Change Wheel. RESULTS: Sixteen clinicians participated in four intra-professional and one interprofessional focus groups. Thematic analysis resulted in two main themes. First, multiple factors influenced primary care teams' ability to address prescribing cascades. Cascades were considered complex in terms of the processes required to identify, investigate, and manage them. Second, the role each profession was able or willing to play varied based on their capability, opportunity, and motivation. Nurse practitioners and physicians felt best equipped to prevent cascades within a patient visit, while pharmacists endorsed being able and willing to address existing cascades. CONCLUSION: The ability to address prescribing cascades is influenced by multiple factors and varied across professions within interprofessional primary care teams. The study findings provide additional information necessary for the design of future interventions to assist clinicians with addressing cascades. Future research should engage patients, caregivers, and community pharmacists to further explore their roles in addressing prescribing cascades.