---
title: "Healthcare professionals’ knowledge, attitude and practice of deprescribing in Gondar, Ethiopia"
id: "bmj-open-3-healthcare-professionals-knowledge-attitude-and-practice-towards-deprescribing"
canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-3-healthcare-professionals-knowledge-attitude-and-practice-towards-deprescribing"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "BMJ Open"
source_url: "http://bmjopen.bmj.com/cgi/content/short/16/7/e112502?rss=1"
published_at: "2026-07-17T10:56:52.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Healthcare professionals’ knowledge, attitude and practice of deprescribing in Gondar, Ethiopia
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-3-healthcare-professionals-knowledge-attitude-and-practice-towards-deprescribing
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** BMJ Open
- **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/7/e112502?rss=1)
- **Published At:** 2026-07-17T10:56:52.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This cross-sectional study (May–June 2025) surveyed 389 healthcare professionals at two public hospitals in Gondar City, Ethiopia, to assess knowledge, attitude and practice (KAP) towards **deprescribing**. - Participants were mainly nurses (65.6%), female (54.2%), aged 21–28 years (46.0%), and primarily graduates of government institutions (88.7%). - Overall, 32% had good knowledge, 51.7% had a positive attitude, and 27.2% demonstrated good practice toward deprescribing; 49% had poor knowledge and 53.3% showed poor practice. - Most respondents (90.5%) had heard of deprescribing of potentially inappropriate medications (PIMs); many identified benzodiazepines and antihypertensives as drug classes suitable for deprescribing. - A majority viewed deprescribing as complex; 78.7% were aware of existing deprescribing guidelines and 55.5% felt they had sufficient knowledge to perform deprescribing, while only 30.1% agreed that additional guidelines were needed. - Practices reported: 76.9% consciously practised deprescribing, 74.3% commonly used tapering, 65.0% documented deprescribing outcomes, and 24.4% had received deprescribing training at work. - Multivariable analysis identified male gender, graduating from a governmental institution and pharmacist profession as positively associated with good knowledge (AORs and 95% CIs reported in source). - Authors recommend integrating **deprescribing** into undergraduate curricula and delivering training for healthcare professionals. - Study limitations include self-reported cross-sectional design, exclusion of patient perspectives, regional scope limiting generalisability, and scarce prior Ethiopian data for comparison.
## Clinical Analysis & Structured Key Points
Skip to main content Intended for healthcare professionals Log In Basket Search for this keyword Advanced search Latest content Archive For authors About Browse by collection You are here Home Archive Volume 16, Issue 7 Email alerts Article Text Article info Citation Tools Share Rapid Responses Article metrics Alerts PDF Health services research Original research Healthcare professionals’ knowledge, attitude, and practice towards deprescribing in Gondar City, Ethiopia: a cross-sectional study http://orcid.org/0000-0001-7676-5147Yeniewa Kerie Anagaw1,2, http://orcid.org/0009-0004-3091-7933Nesrela Abdela Hussen1, Yihune Melak Ayalew1, Meseret Mulugeta Yiheyis3, Marshet Mulugeta Yeheyis4, http://orcid.org/0000-0001-8504-8430Wondim Ayenew5, http://orcid.org/0000-0001-8799-7146Biset Asrade Mekonnen2, http://orcid.org/0000-0001-9442-5234Teshome Bitew Demelash6, Workye Tsehayu7, Yohannes Wobie Wondimhunegn8 Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia Department of General Medicine, Simegn Kebede Health Center, Addis Ababa, Ethiopia Department of Internal Medicine, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Science, Debre Berhan University, Debre Birhan, Ethiopia Mettema General Hospital, Mettema, Ethiopia Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia Correspondence to Yeniewa Kerie Anagaw; yeniewa21@gmail.com Abstract Objective To assess healthcare professionals’ knowledge, attitudes, and practices (KAP) towards deprescribing. Design A facility-based cross-sectional study was conducted from May to June 2025. Setting Two public hospitals in Gondar, Ethiopia. Participants A total of 389 healthcare professionals participated in this study with a 92.2% response rate. Outcomes We assessed healthcare professionals’ KAP towards deprescribing as the primary outcomes. These were measured using a structured, self-administered questionnaire. Results The majority of participants were female (54.2%), and the largest age group was 21–28 years (46.0%). The study revealed that most of the study participants were nurses (65.6%), with most (88.7%) graduating from government institutions. The overall proportion of participants with good knowledge of deprescribing was 32%, while 51.7% had a positive attitude and 27.2% demonstrated good practice. The multivariable analysis revealed that male participants (AOR=2.866, 95% CI 1.734 to 4.737), graduating from a governmental institution (AOR=2.895, 95% CI 1.244 to 6.736) and being a pharmacist (AOR=4.115, 95% CI 1.678 to 10.090) were also positively associated with good knowledge. Conclusions Among the participants, nearly half (49%) of healthcare providers demonstrated poor knowledge of deprescribing, while more than half (53.3%) showed poor practice. Overall, the study highlights that healthcare professionals have limited awareness of deprescribing. Therefore, deprescribing should be incorporated into undergraduate curricula and training should be provided for healthcare professionals. Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/. https://doi.org/10.1136/bmjopen-2025-112502 Request Permissions If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways. STRENGTHS AND LIMITATIONS OF THIS STUDY This study used a cross-sectional design based on self-reported responses from healthcare professionals. The study included different categories of healthcare professionals involved in patient care and medication management. The study did not assess patient-related factors, perspectives or preferences regarding deprescribing. Limited prior studies in Ethiopia and the study area have restricted opportunities for comparison with the existing literature. The study was restricted to a specific region of the country, which may limit the direct generalisability of the methodological findings to other healthcare contexts. Introduction Polypharmacy, commonly defined as the concurrent use of five or more daily medications by a single patient, significantly increases the risk of various adverse clinical outcomes.1 However, deprescribing directly mitigates the risks of polypharmacy by reducing pill burden, minimising drug interactions, preventing adverse reactions and improving adherence.2 Deprescribing refers to the planned process of tapering, discontinuing or withdrawing medications to manage polypharmacy and improve patient outcomes.2–6 It is a clinical strategy used by healthcare professionals to optimise treatment by removing unnecessary drugs or those that no longer provide meaningful benefits.7 Deprescribing is especially important in older adults with multimorbidity, who are often prescribed medications where potential risks outweigh the benefits.6 8 Older adults with multiple chronic conditions are more likely to experience polypharmacy and face a higher risk of medication-related problems.9 With advancing age, changes in physiology, renal and hepatic function, body composition and cellular metabolism alter the distribution and metabolism of medicines.10 As a result, drugs that are therapeutic in younger adults may become less effective or potentially toxic in older adults.10 11 Furthermore, as the number of medications increases, so does the risk of adverse drug reactions, drug–drug interactions, drug–disease interactions and medication errors.10 For example, long-acting sulfonylureas have a high hypoglycaemic risk in elderly patients, particularly patients taking more than one antihypoglycaemic agent.12 Long-term use of high-dose first-generation antipsychotics is associated with a reduction in cortical volume and an increase in ventricular volume.13–15 Chronic administration of antipsychotics may also impair performance on memory-related tasks, including spatial and working memory.13 Furthermore, inappropriate duration of antibiotic use can potentially lead to antimicrobial resistance and increase the necessity to use more expensive antibiotics to treat common and life-threatening infections.16–18 To minimise these risks, certain drug classes, including antipsychotics, benzodiazepines (BZN), proton pump inhibitors, non-steroidal anti-inflammatory drugs, antihypertensives, statins, anticholinergics, hypoglycaemics and opioids are recommended for deprescribing when appropriate.19 Approximately one-third of elderly individuals in developed countries are prescribed five or more medications, and the number of prescriptions prescribed usually increases with age.4 A review of polypharmacy in elderly populations revealed that the highest rates of polypharmacy occurred in the Czech Republic (39.9%), Israel (37.5%) and Portugal (36.9%), whereas the lowest rates were observed in Switzerland (26.3%), Croatia (27.3%) and Slovenia (28.1%).20 However, a study conducted in older hospitalised patients (aged 60 years and above) in India found that 45% of them were experiencing polypharmacy.21 Furthermore, the prevalence of polypharmacy among older adults in Ethiopia is 37.1%.22 This can be due to multimorbidity or having many chronic diseases like stroke, diabetes mellitus, asthma, hypertension and others.4 23 The number of medications a patient takes is a factor strongly associated with inappropriate prescribing and the risk of adverse drug events.4 24 Healthcare professionals should have appropriate knowledge, attitude and be equipped with deprescribing guidelines for an effective deprescribing process. However, its implementation remains inconsistent worldwide. In Nigeria, while 80% of physicians recognised the term ‘deprescribing,’ only 23% were familiar with evidence-based tools like the Beers or Screening Tool of Older Persons’ Potentially Inappropriate/Screening Tool to Alert Doctors to the Right Treatment criteria, which guide safe medication reviews, 22.2% reported they deprescribe daily during consultations and only 20% of the physicians have had previous training on deprescribing.25 In Ethiopia, because of a highly overburdened health system and loss of close monitoring, there is a high risk of drug therapy problems, particularly in chronic patients.26 This problem is worse in patients who live in rural areas, because of the inaccessibility of health facilities and patients’ unawareness of the medication. There is a high chance of developing polypharmacy in older patients. Polypharmacy has been associated with an increase in overall patient burden, increased risk of adverse events, medication non-adherence and, most importantly, increased use of potentially inappropriate medications (PIMs).27 With ageing, older adults experience a higher prevalence of illnesses, including chronic conditions, which often lead to the concurrent use of multiple medications for treatment and management.25 Such prescribing practices can result in drug–drug interactions and drug–food interactions, all of which contribute to increased morbidity and mortality rates, as well as higher healthcare costs.28 The cost of healthcare, particularly medication expenses, is increasing. The use of PIMs for older adults in healthcare facilities is high, representing a substantial and avoidable expense. Notably, 84% of prescribed medications in this context are identified as PIMs.29 Limited studies have been conducted in Ethiopia on healthcare professionals’ awareness of deprescribing. Therefore, this study aimed to assess healthcare professionals’ knowledge, attitudes and practices (KAP) towards deprescribing. Methodology Study design, period and area A facility-based cross-sectional study among healthcare professionals in selected health facilities was conducted from 9 May to June 2025. The study was conducted at University of Gondar Comprehensives Specialized Hospital (UOGCSH) and Ayira General Hospital in Gondar City, Amhara region, Ethiopia. Gondar is located 730 km from Addis Ababa,30 the capital city of Ethiopia. The city has 8 public health centres, 14 health posts, 32 private clinics, 1 general hospital and 1 referral hospital. Source and study population The source population comprised all healthcare professionals working in UOGCSH and Ayira General Hospital. However, the study population included physicians, nurses and pharmacists who were present and providing services in the selected hospitals during the study period, and who fulfilled the inclusion criteria. Eligibility criteria Healthcare professionals who were directly involved in deprescribing activity, on duty at the selected health facilities and willing to provide information during the study period were included in the study. However, the study excluded midwives, laboratory personnel, non-healthcare staff and professionals who were not directly engaged in deprescribing activities or who declined to participate. Sample size and sampling technique The sample size was initially calculated using the single population proportion formula (Eq. 1), with a 95% confidence level and a 5% margin of error. Based on this calculation, the required sample was 384. After adjusting for a 10% non-response rate, the final sample size was 422 participants. According to the 2025 hospital human resources report, the source population comprised 1501 full-time healthcare professionals, including 139 from Ayira General Hospital and 1362 from UOGCSH. The sample was proportionally allocated to the two institutions according to their population sizes. Hence, 39 participants were selected from Ayira General Hospital and 383 from UOGCSH. (1) Data collection methods, tools and procedures A structured questionnaire was developed by reviewing previously published literature12 25 31–35 with some modifications. The questionnaire was tailored to align with the study’s context and objectives and was developed using the Kobo toolbox. It was then programmed into the Kobo Toolbox software. Participants were asked for their consent to confirm their willingness to participate in the study. Hence, participants who responded ‘no’ did not access the tool and missed the study. The tool was explained in detail and distributed to participants through Telegram or email. Participants then completed the questionnaire using a self-administered method via the Kobo tool link. We worked to mitigate potential sampling biases and crafted the questionnaire to be clear, relevant and easily comprehensible. Additionally, to validate the survey, a pretest was conducted with 5% healthcare professionals who were directly involved in deprescribing activity before the actual data collection. An ethical clearance letter was received from the University of Gondar School of Pharmacy Ethical Review Board on 8 May 2025. KAP assessment Knowledge of deprescribing was evaluated using 30 items. Each correct answer received a score of 1, while an incorrect answer received a score of 0. The total possible score was 30, with a minimum score of 0. The participants’ knowledge was classified according to Bloom’s cut-off points into ‘good’ (>80%), ‘moderate’ (60%–80%) or ‘poor’ ( 70% were categorised as negative, moderate and positive attitudes and practices, respectively.39–41 Data analysis The collected data were checked for cleanness and completeness and inserted for data analysis into the SPSS V.25. Finally, descriptive analysis was employed to summarise the findings. Descriptive statistics like frequencies, means and SDs were calculated. The 95% CI was used to identify the presence and strength of association between dependent and independent variable(s). Each variable was first analysed by using bivariate logistic regression (bivariate analysis), and independent variables having a p value of less than 0.25 were entered into a multivariate logistic regression model for final analysis. Goodness-of-fit tests were conducted to assess the suitability of the regression model for the data. Multicollinearity was checked using the variance inflation factor. Outliers and missing data were addressed, and the procedure for entering predictor variables was clearly described and applied. Moreover, internal consistency of the items was assessed using Cronbach’s α, which was 0.84. All candidate variables were included in the multivariate logistic regression analysis. Finally, crude OR and adjusted OR (AOR) with 95% CIs and p<0.05 were considered to indicate significant associations. Patient and public involvement Patients and the public were not involved in the design, conduct, reporting or dissemination of this study. Result Sociodemographic characteristics of participants A total of 389 healthcare professionals participated in this study, with a 92.2% response rate. More than half of the participants were female (54.2%), and the largest age group was 21–28 years (46.0%), followed by 29–35 years (30.1%). Most participants were single (66.1%), and a significant proportion (91.5%) worked at the UOGCSH. In this study, most of the participants were nurses (65.6%), followed by senior doctors (18.0%). In terms of experience, nearly half (48.3%) had 0–4 years of work experience, and most (88.7%) were graduates from government institutions (table 1). VIEW INLINE VIEW POPUP Table 1 Frequency distribution of sociodemographic characteristics of healthcare professionals in Gondar City Healthcare professionals’ knowledge of deprescribing The majority (90.5%) had heard about the deprescribing of PIM. Most respondents acknowledged that deprescribing is appropriate for several patient groups, particularly those on polypharmacy (71.0%), followed by patients receiving long-term medications for chronic conditions (66.1%) and older adults aged 65 years and above (61.7%). With respect to knowledge of drug classes suitable for deprescribing, a high proportion of respondents identified BZN (54.2%), followed by antihypertensives (43.4%). Approximately four-fifths of the participants perceived deprescribing as a multifaceted challenge. More than three-fourths (78.7%) were aware of existing deprescribing guidelines, and over half (55.5%) felt they had sufficient knowledge to carry out deprescribing. In contrast, less than one-third (30.1%) agreed that additional guidelines are needed (table 2). VIEW INLINE VIEW POPUP Table 2 Frequency distribution of healthcare professionals’ knowledge on deprescribing in Gondar City Among the research participants, 49% of healthcare providers demonstrated a poor level of knowledge about deprescribing (figure 1). Download figure Open in new tab Download powerpoint Figure 1 Overall knowledge of healthcare professionals. Healthcare professionals’ attitude towards deprescribing About two-thirds of the participants (65.8%) strongly agreed that providing training to healthcare providers is essential for effective deprescribing, followed by establishing a standardised multidisciplinary team (58.6%) and recognising that deprescribing helps improve patients’ quality of life (57.8%) (figure 2). The overall assessment of participant attitude revealed that 51.7% of healthcare providers had a positive attitude towards deprescribing (figure 3). Download figure Open in new tab Download powerpoint Figure 2 Healthcare professionals’ attitude towards deprescribing. Download figure Open in new tab Download powerpoint Figure 3 Overall attitude and practice score of healthcare professionals. Healthcare professionals’ practices towards deprescribing More than three-fourths of the participants (76.9%) reported consciously practising deprescribing, and a similar proportion (74.3%) indicated that they most often used a tapering-down approach. However, less than one-fourth (24.4%) had received training on deprescribing during their work experience. In addition, more than three-fifths (65.0%) documented the outcomes of deprescribing, and over half (53.2%) most frequently deprescribed long-acting sulfonylureas (table 3). The overall practice-level classification revealed that only about one-third (27.2%) of healthcare professionals demonstrated good practice towards deprescribing, whereas more than half (55.3%) exhi
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