Perceived Confidence and Barriers of Family Physicians Toward Deprescribing Potentially Inappropriate and Preventive Medications in Older Adults: A Cross-Sectional Survey in Riyadh, Saudi Arabia

Polypharmacy is common among older adults and increases the risk of inappropriate medication use and adverse outcomes. Deprescribing is a potential strategy to optimize treatment. This study evaluated family physicians’ confidence and perceived barriers toward deprescribing in primary care in Riyadh, Saudi Arabia. We conducted a cross-sectional survey from January 1 to December 31, 2024, among family physicians working in Riyadh primary care centers. Physicians with < 6 months of experience were excluded. Data were collected using paper-based or electronic questionnaires. Descriptive statistics summarized responses. Group comparisons used chi-square, Student’s t-test, and one-way ANOVA, as appropriate. Associations between confidence and attitude/barrier items were examined using Pearson’s correlation coefficients (r) with two-sided p-values (< 0.05 considered significant). A total of 321 physicians were included, representing 83.6% of the planned sample (321/384). Overall, 64.2% of physicians reported confidence in deprescribing, but only 28.0% reported deprescribing at least weekly. Commonly reported barriers included lack of solid evidence, time constraints, and concern about withdrawal effects. Confidence was positively associated with support for deprescribing preventive medications in patients with limited life expectancy (r = 0.259, p < 0.001), willingness to deprescribe medications initiated by another physician (r = 0.508, p < 0.001), and perceived ease of motivating patients/caregivers (r = 0.506, p < 0.001). Family physicians in Riyadh reported substantial confidence in deprescribing, yet regular implementation was limited, indicating a confidence–practice gap. Addressing key barriers through practical guidance, workflow support, and targeted training may improve deprescribing uptake and medication safety for older adults.