Table 2.

Clinician-Perceived Barriers to Optimizing Prescribing in Dementia

SubthemeRepresentative Quotation
Lack of dataNot only do I have to look at the evidence, but I also have to look at the whole patient…I can't just focus on the guidelines…So many of these decisions are subjective rather than objective. (primary care provider)
Difficulty of assessing medication effects in an individual patientI would always do a little of the typical delirium check like, “Does a stone float?” I often ask them, “Do you see anything you think isn't there or do you hear anything you think isn't happening?” (primary care provider)
Need to consider caregiver availability, knowledge, and skills in prescribing decisionsI have limited time with patients so I…really need to be selective about who I end up talking to about [behavioral strategies to treat incontinence]. If it's someone who's lucky to have someone even looking in on them once a day, then what's the point of talking to them about that? (urogynecologist)
Perceptions of patient and caregiver beliefs and expectationsCaregivers worry about this decision means I gave up on mom or that I'm her executioner because I stopped that med. (primary care provider)
Cognitive biasesI told the daughter, “I really don't see having this cholesterol lowering medicine.” It seemed like within maybe just 2 months, she went into the ER and she had a stroke. (primary care provider)
System barriersMaybe it is my place, but I'm not very good at calling another specialist and saying, “I'm concerned about this…” I'm the generalist. I'm not the specialist. They know more than I do; this is their area. (primary care provider)