Knowledge, barriers, attitude, perception, and ability of public and private institution graduating pharmacy students toward deprescribing and polypharmacy: a cross-sectional survey study in Northwest Ethiopia

Polypharmacy is a simultaneous use of multiple drugs (five or more drugs for general polypharmacy and more than two drugs for psychotropic polypharmacy). If unmanaged, it may lead to an increased incidence of problems like adverse drug reactions which in turn resulted initiation of deprescribing as a solution. For effective implementation of deprescribing, equipping pharmacy students with adequate knowledge and training through a well-structured curriculum is important. Evaluating both the attitudes and perceptions of students for polypharmacy and deprescribing is crucial to modify the curriculum and shape educational strategies. Therefore, the objective of this study was to assess the attitudes and perceptions of graduating pharmacy students toward polypharmacy and deprescribing in Colleges and Universities in northwest Ethiopia. A cross-sectional survey study was conducted among graduating degree pharmacy students from licensed governmental and non-governmental higher institutions from 15 May to 30 November 2024 using both online and paper based structured questionnaires. Data werecollected from 205 graduating students. The collected data were analyzed using SPSS version 24 using ANOVA, Post Hoc, and t-tests. A p value of less than 0.05 was considered significant. The majority (58%) of the participants were not familiar about deprescribing while 85.9% heard about the term polypharmacy. Less than half of participants (42.9%) identified the definition of deprescribing, while 45.4% and 18.5% were able to identify the minimum number of drugs to declare general polypharmacy and psychotropic polypharmacy respectively. About 17.1% of students reported they got curriculum based education on deprescribing while 64.4% on polypharmacy. Near to three-fourth (74.2%) and 75.2% of the students reported that they got inadequate education on deprescribing and polypharmacy respectively. Students from government institutions reported that their school curriculum prepared them to deprescribe medications better as compared with students from private institutions (2.86 ± 0.12 vs. 1.15 ± 0.03, p < 0.001). Similarly students from government institutions declared they have better ability to deprescribe medications than private institution students (p < 0.001). Furthermore, government institution students have better attitude and confidence (p < 0.001) to deprescribe medications as compared to private institution students. The common barriers for deprescribing are related to problems in the curriculum, inadequate preparation of graduating pharmacy students, and patients’ willingness. This study highlighted inadequate knowledge and practice of students on deprescribing and polypharmacy and a need for curriculum reform to equip students with appropriate knowledge and skill about deprescribing and polypharmacy in Ethiopian pharmacy schools. The reform should also include securing appropriate content in the curriculum, curriculum standardization across institutions, and fostering active learning strategies.