Assertive Self-Expression Crucial in Community Pharmacist Deprescribing
Researchers explored various types of self-expression among pharmacists and how they were associated with experience in community pharmacy-led deprescribing.
Community pharmacists exhibiting assertive self-expression were associated with greater experience in deprescribing, according to a study published in Research in Social and Administrative Pharmacy.1 Future research should focus on the association between assertive self-expression and whether or not it increases pharmacist-led deprescribing.
“Improvement in polypharmacy is described as deprescribing, which is defined as ‘the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient's care goals, current level of functioning, life expectancy, values, and preferences,’” wrote authors of the study. “Previous studies have reported that facilitators of deprescribing include education for prescribing physicians, patient preference, patient centeredness, and collaboration among multidisciplinary professionals.”
Many pharmacists and providers with prescribing abilities need to utilize polypharmacy approaches to serve their patients, which in turn could lead to the need for deprescribing. | image credit: hankimage9 / stock.adobe.com
Amid an aging global population and 42% of US patients with 2 or more chronic diseases,2 many pharmacists and providers with prescribing abilities need to utilize polypharmacy approaches to serve their patients. According to a systematic review of all definitions, the most commonly used definition of polypharmacy is when a patient is actively taking 5 or more prescription medications each day.3
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Since the increase of medication use and chronic diseases, deprescribing has risen as a key facilitator in managing polypharmacy. As researchers of the current study stated, deprescribing is reliant on the context of each individual patient, in which a drug’s potential benefits and harms can be significantly different across patient profiles. Researchers showed their desire to explore community pharmacist-led deprescribing because of its known ability to reduce the number of medicines as well as mortality rates among the elderly population.1
In order to discover the factors that lead to better facilitation of deprescribing, researchers’ goal was to explore the skills of community pharmacists—specifically their self-expression.
“Our objective was to test our hypothesis that community pharmacists with higher levels of assertiveness are more likely to experience community pharmacist-led deprescribing,” they wrote.1 “The outcome variable was experience of community pharmacist-led deprescribing during the past year. Community pharmacist-led deprescribing was defined as the discontinuation of 2 or more medicines for at least 4 weeks for a patient with polypharmacy (6 or more different medicines taken daily) based on a suggestion to a physician in accordance with the patient's preference for deprescribing.”
With community pharmacists as the key study participants, they were only included if they dispensed prescriptions between 9:00 am and 7:00 pm and had contact with a physician. Participants were asked to complete a survey and data were collected from May to October 2022 across pharmacies in Japan.
A total of 963 community pharmacists (mean age, 37.9 years; 55.2% women) were included in the final analysis. Of all participants that completed the survey, 15.7% had experience deprescribing, while 84.3% did not.
“In this study, assertive self-expression by community pharmacists was associated with community pharmacist-led deprescribing, while nonassertive and aggressive self-expression were not. To the best of our knowledge, this is the first study to demonstrate an association between community pharmacists’ assertiveness and community pharmacist-led deprescribing,” continued authors of the study.1
Indeed, the researchers’ study was unique in the fact that it explored an association between a pharmacist’s interpersonal skills and one of their day-to-day services. With their hypothesis that assertiveness translated to experience deprescribing, researchers correctly predicted the importance of self-expression in facilitating the discontinuation of patients’ prescription drug regimens.
Their key findings were a significant association between assertiveness and deprescribing experience, while no associations were found between experience deprescribing and non-assertive, or aggressive, community pharmacists.
“Our results show that community pharmacists with high assertive self-expression were more likely to experience community pharmacist-led deprescribing than those with low assertive self-expression,” they wrote.1 “In contrast, our results show that community pharmacists' nonassertive or aggressive self-expression is not associated with experience of community pharmacist-led deprescribing.”
With significant success in identifying this association, future research will focus on seeking more pharmacist skills that can make a crucial difference in the health outcomes of their patients. Specifically for deprescribing, however, researchers are aiming to further understand whether or not assertive pharmacists can increase deprescribing rates among their patient populations.
“Assertive self-expression by community pharmacists is associated with experience of community pharmacist-led deprescribing,” concluded the authors.1 “Assertive self-expression by community pharmacists is a communication skill associated with less polypharmacy. Future research should focus on examining whether enhancing assertive self-expression leads to increased community pharmacist-led deprescribing.”
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References
1. Ishii M, Ozone S, Masumoto S, et al. Assertiveness in community pharmacists and their experience of pharmacist-led deprescribing: a cross-sectional study. RSAP. Published online March 6, 2025. https://doi.org/10.1016/j.sapharm.2025.03.002
2. Benavidez GA, Zahnd WE, Hung P, et al. Chronic disease prevalence in the US: sociodemographic and geographic variations by zip code tabulation area. Prev Chronic Dis. 2024;21(21). https://doi.org/10.5888/pcd21.230267
3. Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? a systematic review of definitions. BMC Geriatr. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2
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