Pharmacists' and physicians' knowledge and attitude regarding deprescribing in Saudi Arabia

Pharmacists’ and physicians’ knowledge and attitude regarding deprescribing in Saudi Arabia Khalid A. Alamer1, Fawaz M. Alotaibi1, Ahmed K. Alalawi2, Ahmed F. Alkudaimi2, Hisham Bukhamseen3, Hussain A. Alaseel4, Danah H. Almansour2, Mohammed M. Aleid2, Mansour M. Alotaibi5 1 Pharmacy practice department, College of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 2 College of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 3 King Fahad Specialist Hospital, Dammam, Eastern Province, Saudi Arabia 4 Prince Mohammed bin Fahd Specialist Hospital for blood diseases, Dammam, Eastern Province, Saudi Arabia 5 Pharmacy practice department, college of clinical pharmacy, King Faisal University, Alhofuf, Eastern Province, Saudi Arabia Corresponding author: Fawaz M. Alotaibi ([email protected]) Received 13 August 2025♦ Accepted 23 September 2025♦ Published 17 October 2025 Citation: Alamer KA, Alotaibi FM, Alalawi AK, Alkudaimi AF, Bukhamseen H, Alaseel HA, Almansour DH, Aleid MM, Alotaibi MM (2025) Pharmacists’ and physicians’ knowledge and attitude regarding deprescribing in Saudi Arabia. Pharmacia 72: 1–8. https:// doi.org/10.3897/pharmacia.72.e168634 Abstract Study Objectives: Our study objectives were to test pharmacists’ and physicians’ knowledge and attitude towards deprescribing in Saudi Arabia. Methods: A survey-based cross-sectional study was performed to answer our research question. We collected study data through a validated survey assessing deprescribing knowledge and attitude, including all pharmacists and physicians who care for older adults or have an interest in this patient population. Data were analyzed using IBM SPSS v27.0. Continuous variables were reported as mean ± SD, and categorical variables were reported as percentages and frequencies. Knowledge level (high vs. low–moderate) was compared across gender, experience quartile, academic degree, and professional role using χ² tests with Cramer’s V and a Bonferroni-corrected α = 0.0125, while attitude was modeled with a forced-entry multiple linear regression including knowledge, age, years of experience, and gender. Results: In total, 238 participants (pharmacists and physicians) completed the survey. The majority were male (65%) and had 4 years’ experience (53%). In addition, 31% worked in community pharmacy, 25% in hospital pharmacy, while physicians represented 31% of study participants. We found a significant positive correlation between knowledge and attitude towards deprescribing, and the majority of participants demonstrated moderately positive attitudes, aligning with the observed knowledge–attitude relationship. Conclusion: Our findings indicate that the majority of healthcare provider participants had a low to moderate level of knowledge about deprescribing. Keywords deprescribing, geriatrics, medication-related problem, older adults, polypharmacy Copyright Alamer KA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pharmacia 72: 1–8 DOI 10.3897/pharmacia.72.e168634 Research Article Alamer KA et al.: Pharmacists and physician’s knowledge, attitude regarding deprescribing2 Introduction Deprescribing is defined as a clinician-supervised and patient-centered process that tapers or discontinues medication when the risk outweighs the expected benefit. The goal of deprescribing is not solely to reduce the number of medications but also to assess the clinical relevance of each medication’s indication, dose, and duration (Thompson and McDonald 2024). The need for deprescribing is driven by the high prevalence of polypharmacy and its associated consequences. Polypharmacy (the concurrent use of five or more medications) affects 39% of older adults around the world, while hyper-polypharmacy (>10 medications) affects 13% (Wang et al. 2024). A recent cross-sectional study conducted in Saudi Arabia reported 66% hyper/polypharmacy among middle-aged and older adults (Alqurain et al. 2024). The clinical consequences of polypharmacy are documented; a recent nationwide large cohort study conducted in Korea highlighted that continuous polypharmacy increased the adjusted odds for hospitalization (OR = 1.32, 95% CI 1.31–1.33), emergency visits (OR = 1.32, 1.31–1.33), and death (OR = 1.63, 1.59–1.67) (Chae et al. 2024). To address this growing challenge, several frameworks have been developed. Linsky and colleagues proposed a novel, comprehensive conceptual framework for deprescribing. The framework separates the decision to deprescribe from the steps required to implement that decision, showing how patients, clinicians, and healthcare systems influence that decision (Linsky et al. 2019). A systematic approach to deprescribing can lead to proven benefits. A 2024 meta-analysis showed that protocol-driven deprescribing significantly reduces mortality in older adults, with subgroup analyses revealing the most significant benefit among the “young old” (aged 65–79) (OR 0.71, 95% CI 0.51–0.99) (Quek et al. 2024). Moreover, in the Irish STOPPFrail intervention involving frail nursing home residents, the average medication count decreased significantly from 16.0 to 14.6 following a pharmacist-led review (p < 0.001) (Hurley et al. 2024). Similarly, in the 2024 MedSafer cluster randomized trial, the use of electronic deprescribing support at hospital discharge significantly increased the proportion of patients with at least one medication deprescribed – 55.4% in the intervention group compared to 29.8% in the control group (aRD: 22.2%; 95% CI: 16.9%–27.4%) – without increasing adverse drug events or withdrawal effects (McDonald et al. 2022). Furthermore, in a pilot study by Noll et al., pharmacist-led deprescribing reduced anticholinergic exposure by 93% in clinic-based care and 42% in telephone-based care, with only 17% of medications being restarted at 6 months and no increase in adverse events (Campbell et al. 2022). Altogether, these findings suggest that deprescribing is an effective way to reduce unnecessary medications and can be implemented safely in routine clinical practice. Despite the positive outcomes, deprescribing is not yet commonly integrated into routine clinical practice. Familiar barriers include limited incentives for consultation time, restricted access to patient medication records, lack of training, and confusion regarding who should initiate deprescribing (Doherty et al. 2020; Abou et al. 2024). A qualitative survey conducted in three tertiary hospitals in Saudi Arabia emphasized similar barriers, highlighting a lack of institutional policies, clinicians’ lack of practical experience, and a low priority given to deprescribing (Alharthi et al. 2025). These restrictions imply that, in addition to tools and interventions, the knowledge, willingness, and motivation of healthcare professionals remain key facilitators of successful deprescribing implementation. Several studies have explored healthcare providers’ perspectives on deprescribing. A Chinese national survey found that pharmacists outperformed physicians in the domain of deprescribing knowledge (Hu et al. 2024). However, both groups cited workload, fear of negative consequences, and the absence of deprescribing guidelines as significant barriers. A Saudi Arabian study on physicians’ attitudes found awareness of deprescribing among physicians, but low self-confidence and varied clinical practices were identified as key challenges (Alrasheed et al. 2018). Building on these findings, Saudi Arabia currently lacks specific regulations for deprescribing; nevertheless, several national healthcare initiatives indirectly support medication optimization. These include the Ministry of Health’s Rational Use of Medicines program; the Health Sector Transformation Program under Vision 2030, which prioritizes reducing preventable medication-related harm; and the recently released Saudi Pharmacotherapy Didactic Curriculum Toolkit (2024), which incorporates deprescribing concepts into geriatric, chronic disease, and patient safety modules. Despite these efforts, it remains unclear how systematically deprescribing practices have been integrated into education and clinical training. These results highlight persisting gaps in knowledge and variability in deprescribing practice among healthcare professionals. Therefore, this study aims to assess pharmacists’ and physicians’ knowledge and attitude regarding the concept of deprescribing in Saudi Arabia – a gap in the literature that we aim to fulfill. Methods Study design This was a cross-sectional survey-based study. Setting Participants were recruited from a range of healthcare settings, including community pharmacies across the Eastern Province, hospital pharmacies, and physicians working closely with older adults (aged 65 years and above). Recruitment was supported by Imam Abdulrahman Bin Faisal University (IAU) Hospitals and affiliated networks, but participation was open to all eligible pharmacists and Pharmacia 72: 1–8 3 physicians in the region. Imam Abdulrahman Bin Faisal University Hospitals (IAU Hospitals) are leading tertiary academic medical centers in the Eastern Province of Saudi Arabia, offering a wide range of inpatient, outpatient, and specialized services. These hospitals also serve as key teaching and research institutions, making them an ideal environment for recruiting healthcare professionals involved in caring for older adults. Data collection Study data were collected through a survey sent to all eligible pharmacists and physicians. Several recruitment methods were used, including: (1) introducing the study to healthcare providers at Imam Abdulrahman Bin Faisal University (IAU) Hospitals, (2) contacting pharmacy leaders to increase the visibility of the study, and (3) encouraging pharmacists who completed the survey to invite their colleagues to participate. These approaches were adopted to facilitate recruitment and maximize participation within a limited timeframe. A convenience sampling approach was used, targeting eligible pharmacists and physicians from IAU Hospitals, affiliated networks, and community pharmacies across the Eastern Province. No a priori sample size calculation was performed, as the study was exploratory in nature; instead, we aimed to recruit as many eligible participants as possible within the study timeframe. Study tool The survey consists of three sections, divided as follows: demographic information (age, gender, years of experience, highest degree, and the role of the healthcare provider in their community). The second section aims to assess knowledge about deprescribing and how pharmacists and physicians can apply this concept in practice. The knowledge section included five true/false items adapted from a previously validated deprescribing instrument developed in a different clinical setting and chosen for alignment with our study objectives. The final score was divided into a high level of knowledge and a moderate/low level of knowledge. Those who scored 4 or 5 were considered high-level performers, while those who scored 3 or below were considered moderate – to low-level performers. In addition, a test–retest analysis was performed to ensure the consistency of the results in this part and to verify the necessary tests. The third part aims to test healthcare providers’ attitudes towards deprescribing, which consists of seven questions with a Likertscale answer format, as exported from (van Poelgeest et al. 2022). Experts in the field of geriatrics reviewed the final survey format and double-checked its contents. Statistical analysis Data were analyzed using IBM SPSS v27.0. Continuous variables were reported as mean ± SD after a Shapiro– Wilk normality check; categorical data as n (%). Scale reliability was gauged with Cronbach’s α (95% CI). Pearson (or Spearman/point-biserial when assumptions failed) correlations explored relationships among knowledge, attitude, age, and experience (two-tailed α = 0.05). Knowledge level (high vs. low–moderate) was compared across gender, experience quartile, academic degree, and professional role using χ² tests with Cramer’s V and a Bonferroni-corrected α = 0.0125. Attitude was modeled with a forced-entry multiple linear regression including knowledge, age, years of experience, and gender; assumptions were verified via Durbin– Watson, residual plots, and VIF < 2. Determinants of high knowledge were examined with univariate and multivariate logistic regression: predictors (attitude, academic degree, professional role) were entered simultaneously, and model fit was assessed with the Hosmer–Lemeshow test, Nagelkerke R², and ROC-curve AUC. Final significance was set at p < 0.05, and all effect estimates are presented with 95% confidence intervals. Reliability The internal consistency of the scales was acceptable to strong. The deprescribing knowledge scale had a Cronbach’s alpha of 0.70, indicating acceptable reliability across its five items. The deprescribing attitude scale showed excellent reliability with a Cronbach’s alpha of 0.87 across seven items, suggesting the items were highly consistent in measuring the same construct. Ethical considerations The study was conducted after obtaining IRB approval from the IAU scientific committee (IRB-2024-05-157). The survey was conducted anonymously, and no personal data were collected besides the questions to which the participants consented. Participants were informed of all the details regarding the study and willingly chose to participate. Results In total, 238 pharmacists and physicians completed the survey. The majority of participants were male (65%) and had 4 years’ experience (53%). In addition, 31% worked in community pharmacy, 25% in hospital pharmacy, while physicians represented 31% of the participants. All other demographic information was reported in Table 2. Notably, the average knowledge score was 3.5, while the average attitude score was 2.38. These descriptive findings indicate that, on average, participants demonstrated low-to-moderate knowledge and moderately positive attitudes toward deprescribing. Table 1. Cronbach’s alpha result among different deprescribing scales. Scale Cronbach’s alpha Number of items Knowledge .70 5 Attitude .87 7 Alamer KA et al.: Pharmacists and physician’s knowledge, attitude regarding deprescribing4 In Table 3a, b, we present the correlation between the knowledge domain and attitude of participants. We found a significant positive correlation between knowledge and attitude toward deprescribing (r = 0.156, p < 0.05). Although the correlation was weak, it suggests that pharmacist and physician healthcare professionals with greater knowledge tend to have more favorable attitudes toward deprescribing. Correlation analysis revealed a small but statistically significant positive association between knowledge and attitude toward deprescribing (r = 0.139, p < 0.05), suggesting that greater knowledge is modestly linked to more favorable attitudes. Knowledge also showed moderate positive correlations with highest academic degree (r = 0.352, p < 0.01) and professional role (r = 0.301, p < 0.01), indicating that these factors may contribute to higher knowledge levels. While years of experience showed a negative correlation with major role (r = –0.235), this association did not reach statistical significance. No significant correlations were observed between gender and any of the main study variables. In addition, Table 4 shows chi-square analysis, in which we found no significant associations between knowledge level and gender (χ² = 0.02, p = 0.881) or years of experience (χ² = 2.48, p = 0.478). In contrast, statistically significant associations were observed between knowledge level and both highest academic degree (χ² = 47.72, p < 0.001) and professional role (χ² = 34.63, p < 0.001). Notably, participants holding an MBBS degree or residency/ higher training had a higher proportion of high knowledge scores compared to other educational backgrounds. Similarly, physicians were disproportionately represented in the high-knowledge group compared to pharmacists and other healthcare roles. Table 3. Pearson correlation between composite knowledge and attitude scores toward deprescribing (N = 238). A Variables 1 2 1. Knowledge 1.00 2. Attitude .156* 1.00 B. Intercorrelations among knowledge, attitude, and key demographic/professional variables (N = 238). Variables 1 2 3 4 5 6 1. Attitude 1 2. Knowledge .139*1 3. Gender -.074 .010 1 4. Years of experience -.113 -.001 -.057 1 5. Highest degree .104 .352** -.112 -.017 1 6. Your major role .100 .301** .078 -.235** .524** 1 *. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed). Table 4. Cross-tabulation of deprescribing knowledge level by demographic and professional characteristics with χ² tests (N = 238). Knowledge Total N (%) Chi square test X2 p Low to moderate N (%) High N (%) Gender Male 114 (50.7) 32 (14.2) 146 (64.9) .02 .881 Female 61 (27.1) 18 (8.0) 79 (35.1) Year of experience 1 49 (21.8) 15 (6.7) 64 (28.4) 2.48 .478 2 20 (8.9) 3 (1.3) 23 (10.2) 3 12 (5.3) 6 (2.7) 18 (8.0) 4 94 (41.8) 26 (11.6) 120 (53.3) Highest degree PharmaD 65 (28.9) 8 (3.6) 73 (32.4) 47.72 <0.001 Ms 11 (4.9) 0 (0.0) 11 (4.9) PhD 8 (3.6) 2 (0.9) 10 (4.4) B.Pharma 51 (22.7) 4 (1.8) 55 (24.4) Residency or higher 20 (8.9) 11 (4.9) 31 (13.8) MBBS 20 (8.9) 25 (11.1) 45 (20.0) Major role Community pharmacist 64 (28.4) 7 (3.1) 71 (31.6) 34.63 <0.001 In-patient pharmacist 26 (11.6) 5 (2.2) 31 (13.8) Out-patient pharmacist 23 (10.2) 2 (0.9) 25 (11.1) Leader in pharmacy 13 (5.8) 3 (1.3) 16 (7.1) Academician in pharmacy 3 (1.3) 1 (0.4) 4 (1.8) Physician 38 (16.9) 32 (14.2) 70 (31.1) Leader in medical field 8 (3.6) 0 (0.0) 8 (3.6) Table 2. Sociodemographic, professional, and survey-score characteristics of study participants (N = 238). Variable Category N % Gender Male 146 64.9 Female 92 35.1 Years of experience 1 64 28.4 2 23 10.2 3 18 8.0 4 120 53.3 Educational background PharmD 73 32.4 Ms 11 4.9 PhD 10 4.4 B. Pharm 55 24.4 Residency or higher 31 13.8 MBBS 45 20.0 Major role Community pharmacist 71 31.6 In-patient pharmacist 31 13.8 Out-patient pharmacist 25 11.1 Leader in pharmacy 16 7.1 Academician in pharmacy 4 1.8 Physician 70 31.1 Leader in medical field 8 3.6 Knowledge category Low to moderate 175 77.8 High 50 22.2 Descriptive table Mean SD Age 31.32 6.85 Knowledge 3.50 1.14 Attitude 2.38 .57 Note: Values for age, knowledge, and attitude are presented as mean ± SD, while categorical demographic and professional variables are presented as n (%). Pharmacia 72: 1–8 5 A linear regression analysis (Table 5) was conducted to examine predictors of attitude scores toward deprescribing. The model was statistically significant (F(4,220) = 2.322, p = 0.05), though it explained a small portion of the variance (R² = 0.041). Among the predictors, knowledge was the only significant factor (B = 0.141, p = 0.035), indicating that higher knowledge scores were associated with more positive attitudes. Other variables, including age, years of experience, and gender, were not significant predictors of attitude in this model. A logistic regression analysis (Table 6) was performed to identify factors associated with being in the high-knowledge group (vs. moderate/low) regarding deprescribing. In the univariate analysis, having a more positive attitude was significantly associated with higher knowledge (OR = 1.93, 95% CI: 1.03–3.62, p = 0.040). However, this association was no longer significant after adjusting for other variables in the multivariate model (OR = 1.617, 95% CI: 0.75–3.46, p = 0.217). Regarding academic qualifications, healthcare professionals with an MBBS degree had significantly higher odds of being in the high-knowledge group compared to those with a PharmD (reference category), both in the univariate (OR = 10.16, p < 0.001) and multivariate models (OR = 12.99, 95% CI: 2.24–75.19, p = 0.004). Those with residency or higher training also had increased odds in the univariate model (OR = 4.47, p = 0.005), which became marginally non-significant after adjustment (OR = 4.57, p = 0.065). Other variables such as gender, years of experience, and primary professional role did not significantly predict high knowledge in the adjusted model. Discussion To our knowledge, this is the first study to report the knowledge and attitudes of healthcare providers (physicians and pharmacists) toward deprescribing in Saudi Arabia. This survey was conducted in two different settings: community pharmacy and hospital practice, which included general practitioners and hospital pharmacists. Although this study investigated the knowledge and attitudes of two different specialties, the results also differed. Physicians and those holding an MBBS degree had higher knowledge than pharmacists with a PharmD degree. This finding aligns with previous reports showing that physicians demonstrated higher knowledge of deprescribing terms and concepts (Chróinín et al. 2015; Mantelli et al. 2018; Jungo et al. 2021). In addition, our findings suggest that experienced healthcare providers have higher knowledge and more positive attitudes toward deprescribing than their peers with less experience. Our findings suggest that healthcare providers, including physicians and hospital and community pharmacists Table 5. Multiple linear regression predicting attitude toward deprescribing from knowledge and selected background characteristics (N ≈ 225). Variables Coefficient (B) 95% CI t p Constant 2.365 [1.98 – 2.74] 12.293 <.000 Age .076 [-.009 – .021] .826 .410 Years of experience -.163 [-.147 – .007] -1.788 .075 Knowledge .141 [.014 – .370] 2.126 .035 Gender (ref-male) -.071 [.289 – .242] -1.064 .289 Note: Outcome variable: attitude; model summary: R² = 0.041, adj R² = 0.023, DW = 1.63; ANOVA: F(4,220) = 2.322, p = 0.05. Table 6. Univariate and multivariable logistic regression identifying predictors of high deprescribing knowledge (N = 238). Univariate unadjusted LR Multivariate analysis Variables Groups ODDS 95% CI pODDS 95% CI p Attitude 1.93 [1.03,3.62] .040 1.617 [.75,3.46] .217 Age 1.00 [0.96,1.05] .848 - - - Gender Male (ref.) - - - Female 1.05 [.55,2.03] .884 - - - Years of experience 1 - - - 2 .49 [.13,1.88] .298 - - - 3 1.63 [.52,5.09] .398 - - - 4 .90 [.43,1.86] .783 - - - Highest degree PharmD - - .064 Ms .000 [.000,.000] .999 .000 [.000,.000] .999 PhD 2.031 [.36,11.28] .418 2.110 [.36,12.32] .407 B. Pharm .637 [.18,2.35] .482 .618 [.16,2.33] .477 Residency or higher 4.469 [1.58,12.64] .005 4.566 [.91,22.98] .065 MBBS 10.156 [3.96,26.02] <0.001 12.989 [2.24,75.19] .004 Major role Community pharmacist .000 .997 In-patient pharmacist 1.758 [.51,6.04] .370 .973 [.22,4.15] .971 Out-patient pharmacist .795 [.15,4.12] .784 .775 [.14,4.11] .765 Leader in pharmacy 2.110 [.48,9.25] .322 1.284 [.22,7.27] .777 Academician in pharmacy 3.048 [.27,33.39] .362 1.445 [.07,32.15] .816 Physician 7.699 [3.09,19.14] <0.001 .753 [.112,4.83] .765 Leader in medical field .000 [.00,.00] .999 .000 [.000,.000] .999 Alamer KA et al.: Pharmacists and physician’s knowledge, attitude regarding deprescribing6 (77%), possess low to moderate knowledge regarding deprescribing, which could be explained by the following: (1) the weak implementation of deprescribing topics early in the program curriculum (MBBS or PharmD) in Saudi universities, (2) the nature of the training that Saudi healthcare providers gained – “pill for every ill,” not the other way around, and (3) the limited involvement of geriatricians (whether physicians or pharmacists) in training other healthcare providers who lack such knowledge and essential skills. Such factors could be overcome by taking the lead from experts in the field of geriatrics to educate healthcare providers and patients regarding the positive outcomes of deprescribing, which will enhance patients’ quality of life and decrease adverse drug reactions (ADRs), hospital readmissions, emergency department visits, and mortality (Woodward 2003; Wu et al. 2021). These results also reveal a logical gap: without structured educational exposure, knowledge of deprescribing cannot develop naturally. Positive attitudes may be present, but meaningful knowledge and consistent practice will only appear once deprescribing concepts are systematically integrated into undergraduate curricula and ongoing professional training programs. Another interesting finding in our results was the difference between MBBS holders and PharmDs in terms of knowledge and attitude. MBBS holders had higher knowledge and more positive attitudes regarding deprescribing than PharmDs. Unfortunately, we could not find a national or international study comparing both specialties in terms of deprescribing knowledge. Our findings were expected due to the nature and policy in Saudi Arabia regarding who should initiate a prescription. Notably, most of our sample pharmacists were community pharmacists, and up to this date, community pharmacists do not have the right to initiate or stop any prescription medication. This may lead to the initiation of a collaborative practice agreement (CPA) policy, which has been practiced and approved since the mid-1990s in the United States. CPAs are practices where clinical pharmacists and healthcare providers sign a legal document to participate in the drug therapy management process, which has proven to improve quality of life, especially for older adults (Bacci et al. 2016; Martin et al. 2020; Kerelos et al. 2023; Adams and Eid 2024). Thus, further studies should be conducted to determine the effectiveness of such an initiative in the Saudi health system. Although physicians have the authority to prescribe, pharmacists play a key role in the deprescribing process by reviewing medications, identifying potentially inappropriate prescriptions, and recommending therapy adjustments. However, deprescribing efforts require shared decision-making among physicians, pharmacists, and patients to ensure safe and acceptable implementation. This collaborative approach is increasingly incorporated into practice agreements and multidisciplinary care models, which support Saudi Arabia’s Vision 2030 health reforms. Therefore, while physicians make the final decision, pharmacists’ expertise makes them a logical focus for deprescribing initiatives. Recognizing that deprescribing is a process that should be implemented in clinical settings such as hospital wards, community pharmacists should also be involved in medication therapy management, which is not yet mandated in our healthcare system. Deprescribing is not only for polypharmacy patients or older adult patients, but also for every patient who misuses or has inappropriate medications on his or her list. Therefore, community pharmacists, with greater exposure to daily cases, are more likely to encounter inappropriate medications across various patient populations. In addition to activating medication therapy management for community pharmacists, we recommend increasing the number of training sessions and topics related to polypharmacy and deprescribing to support their success in the deprescribing initiative, which we currently lack in our local health system, to the best of our knowledge. Furthermore, Saudi Arabia’s healthcare system is undergoing significant transformations to accommodate epidemiological and demographic shifts, as outlined in Vision 2030 (Albabtain et al. 2021). Our study has several strengths and limitations. This is the first comprehensive study to combine MBBS and PharmD graduates and test their knowledge and attitudes toward deprescribing. We focused on physicians and pharmacists, rather than their specialty (geriatrics), to test the real-life knowledge of general practitioners and community pharmacists. Additionally, our study has several limitations: (1) the low sample size, which prevented us from capturing more practitioners due to their busy schedules and the length and nature of the survey; (2) no a priori sample size calculation was performed, as the study used a convenience sampling approach – rather, we aimed to recruit as many participants as possible within the study timeframe; and (3) the low generalizability of our findings, further limited by the predominance of participants from Eastern Province hospitals, which provided our data collection team with easier access and limited connections to other regions. In our survey, we could not assess the barriers and facilitators that were of interest, but due to the scope of our study aims and the length of the survey, we could not capture such information that would enrich the discussion. Future perspectives Our study enhanced our understanding of the initiative in the Kingdom of Saudi Arabia regarding deprescribing, which will be an area of local research focus. Our findings suggest that several workshops and training sessions should be implemented for healthcare providers to increase awareness of deprescribing, which requires further collaboration between Saudi universities (health colleges) and hospitals in the region. Future studies should also explore barriers and facilitators to deprescribing in Saudi healthcare settings, as these insights would offer a deeper understanding of implementation challenges and help design more effective strategy interventions. In addition, such topics could be covered at local conferences to increase their publicity and importance. The implementation of collaborative healthcare models, where physicians, pharmacists, and other healthcare professionals work synergistically, has Pharmacia 72: 1–8 7 demonstrated improved patient outcomes, reduced medication-related problems, and enhanced adherence to therapeutic regimens in various international healthcare settings. This approach will not only foster mutual respect and understanding among healthcare professionals but also clarify and solidify the pharmacist’s role in direct patient care, ultimately leading to a more cohesive and effective healthcare delivery system (Rasheed et al. 2023). Conclusion Our study findings indicate that the majority of healthcare provider participants had a low to moderate level of knowledge about deprescribing. We recommend holding training sessions and workshops for hospital staff to increase awareness of this crucial topic, specifically for the elderly as well as for the general population. Such an initiative will lead to better health outcomes and improve quality of life for the elderly, which will increase the average life expectancy of Saudi individuals – one of the objectives in the health track of Vision 2030. Acknowledgments We sincerely thank all the pharmacists and physicians who took a moment from their busy schedules to complete the survey and provide their insights for a better future of pharmacy services. Additional information Conflict of interest The authors have declared that no competing interests exist. Ethical statements The authors declared that no clinical trials were used in the present study. The authors declared that no experiments on humans or human tissues were performed for the present study. Informed consent from the humans, donors or donors’ representatives: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Imam Abdulrahman Bin Faisal University (IRB2024-05-157) for studies involving humans. Informed consent was obtained from all subjects involved in the study before they started filling out the survey. In addition, no identifiable data have been exposed to the researchers or the data analyst. All data has been stored and locked in a secure place until the date of publications according to IAU publications policy. The authors declared that no experiments on animals were performed for the present study. The authors declared that no commercially available immortalised human and animal cell lines were used in the present study. Use of AI No use of AI was reported. Funding No funding was reported. Author contributions Alotaibi FM, Alamer KA, and Alotaibi MM participated in the conceptualization of this work. Alamer KA performed the data analysis. Alalawi AK, Alkudaimi AF, Bukhamseen H, Alaseel HA, Almansour DH, and Aleid MM contributed to data collection. Alotaibi FM and Alamer KA wrote the first draft of the manuscript. All authors approved the final manuscript. Author ORCIDs Khalid A. Alamer https://orcid.org/0009-0002-7893-7488 Fawaz M. Alotaibi https://orcid.org/0000-0002-4247-6846 Mansour M. Alotaibi https://orcid.org/0000-0003-4614-2293 Data availability All the data of this research are presented in this paper; however, the raw data are available upon request from the corresponding author (Alotaibi FM). References Abou J, Crutzen S, Tromp V, Heringa M, Van Marum R, Elders P, Taxis K, Denig P, Hugtenburg J (2022) Barriers and enablers of healthcare providers to deprescribe cardiometabolic medication in older patients: A focus group study. Drugs & Aging 39(3): 209–221. https:// doi.org/10.1007/s40266-021-00918-7 Adams AJ, Eid DD (2024) Toward collaborative practice, not collaborative practice agreements. American Journal of Health-System Pharmacy 81(7): e157–e158. https://doi.org/10.1093/ajhp/zxad280 Albabtain B, Hadi MA, Bawazeer G, Alqahtani A, Bahatheq A, Alhossan A, Cheema E (2021) Evaluation of a community pharmacy-based medication therapy management programme: A study protocol of a pilot randomized controlled trial with an embedded qualitative study. Saudi Pharmaceutical Journal 29(7): 706–712. https://doi. org/10.1016/j.jsps.2021.05.001 Alharthi MS (2025) Barriers and facilitators to proactive deprescribing in Saudi hospitals: A qualitative study using the theoretical domains framework. Healthcare 13(11): e1274. https://doi.org/10.3390/ healthcare13111274 Alqurain AA, Albaharnah M, Al Zayer S, Ameer L, Ghosn S, Al-Shaibi S, Algoraini M, Aldhafeeri A, Alyusuf DA, Alshnbari A, Alsaffar N, Al-Matouq J, Al Khamees M, AlAlwan B, Alomar FA (2024) The prevalence of polypharmacy and hyper-polypharmacy among middle-aged vs. older patients in Saudi Arabia: A cross-sectional study. Frontiers in Pharmacology 15: e1357171. https://doi.org/10.3389/ fphar.2024.1357171 Alrasheed MM, Alhawassi TM, Alanazi A, Aloudah N, Khurshid F, Alsultan M (2018) Knowledge and willingness of physicians about deprescribing among older patients: A qualitative study. Clinical Alamer KA et al.: Pharmacists and physician’s knowledge, attitude regarding deprescribing8 Interventions in Aging 13: 1401–1408. https://doi.org/10.2147/CIA. S165588 Bacci JL, Coley KC, McGrath K, Abraham O, Adams AJ, McGivney MS (2016) Strategies to facilitate the implementation of collaborative practice agreements in chain community pharmacies. Journal of the American Pharmacists Association 56(3): 257–265. https://doi. org/10.1016/j.japh.2016.02.014 Campbell NL, Pitts C, Corvari C, Kaehr E, Alamer K, Chand P, Nanagas K, Callahan CM, Boustani MA (2022) Deprescribing anticholinergics in primary care older adults: Experience from two models and impact on a continuous measure of exposure. Journal of the American College of Clinical Pharmacy 5(10): 1039–1047. https://doi. org/10.1002/jac5.1682 Chae J, Cho HJ, Yoon S-H, Kim D-S (2024) The association between continuous polypharmacy and hospitalization, emergency department visits, and death in older adults: A nationwide large cohort study. Frontiers in Pharmacology 15: e1382990. https://doi.org/10.3389/ fphar.2024.1382990 Doherty AJ, Boland P, Reed J, Clegg AJ, Stephani A-M, Williams NH, Shaw B, Hedgecoe L, Hill R, Walker L (2020) Barriers and facilitators to deprescribing in primary care: A systematic review. BJGP Open 4(3): bjgpopen20X101096. https://doi.org/10.3399/bjgpopen20X101096 Hu X, Liu R, Tang L, Mei M, Li Y, Tang G, Feng J, Chen W, Li G (2024) Physicians and hospital pharmacists’ knowledge, attitudes, and practices towards polypharmacy in older patients with chronic diseases. Scientific Reports 14(1): 1–11. https://doi.org/10.1038/s41598-02480989-9 Hurley E, Dalton K, Byrne S, Foley T, Walsh E (2024) Pharmacist-led deprescribing using STOPPFrail for frail older adults in nursing homes. Journal of the American Medical Directors Association 25(9): e105122. https://doi.org/10.1016/j.jamda.2024.105122 Jungo KT, Mantelli S, Rozsnyai Z, Missiou A, Kitanovska BG, Weltermann B, Mallen C, Collins C, Bonfim D, Kurpas D, Petrazzuoli F, Dumitra G, Thulesius H, Lingner H, Johansen KL, Wallis K, Hoffmann K, Peremans L, Pilv L, Šter MP, Bleckwenn M, Sattler M, van der Ploeg M, Torzsa P, Kánská PB, Vinker S, Assenova R, Bravo RG, Viegas RPA, Tsopra R, Pestic SK, Gintere S, Koskela TH, Lazic V, Tkachenko V, Reeve E, Luymes C, Poortvliet RKE, Rodondi N, Gussekloo J, Streit S (2021) General practitioners’ deprescribing decisions in older adults with polypharmacy: A case vignette study in 31 countries. BMC Geriatrics 21(1): 1–12. https://doi.org/10.1186/ s12877-020-01953-6 Kerelos T, Gangoo-Dookhan T (2023) The impact of pharmacists engaged in collaborative practice agreements in the United States. Journal of Pharmacy Practice 36(6): 1480–1484. https://doi. org/10.1177/08971900221116684 Linsky A, Gellad WF, Linder JA, Friedberg MW (2019) Advancing the science of deprescribing: A novel comprehensive conceptual framework. Journal of the American Geriatrics Society 67(10): 2018–2022. https://doi.org/10.1111/jgs.16136 Mantelli S, Jungo KT, Rozsnyai Z, Reeve E, Luymes CH, Poortvliet RKE, Chiolero A, Rodondi N, Gussekloo J, Streit S (2018) How general practitioners would deprescribe in frail oldest-old with polypharmacy – The LESS study.”. BMC Family Practice 19(1): 1–8. https://doi. org/10.1186/s12875-018-0856-9 Martin B, Phoenix BJ, Chapman SA (2020) How collaborative practice agreements impede the provision of vital behavioral health services. Nursing Outlook 68(5): 581–590. https://doi.org/10.1016/j.outlook.2020.04.002 McDonald EG, Wu PE, Rashidi B, Wilson MG, Bortolussi-Courval É, Atique A, Battu K, Bonnici A, Elsayed S, Wilson AG, Papillon-Ferland L, Pilote L, Porter S, Murphy J, Ross SB, Shiu J, Tamblyn R, Whitty R, Xu J, Fabreau G, Haddad T, Palepu A, Khan N, McAlister FA, Downar J, Huang AR, MacMillan TE, Cavalcanti RB, Lee TC (2022) The MedSafer study – electronic decision support for deprescribing in hospitalized older adults: A cluster randomized clinical trial. JAMA Internal Medicine 182(3): 265–273. https://doi.org/10.1001/ jamainternmed.2021.7429 Ní Chróinín D, Ní Chróinín C, Beveridge A (2015) Factors influencing deprescribing habits among geriatricians. Age and Ageing 44(4): 704–708. https://doi.org/10.1093/ageing/afv028 Quek HW, Page A, Lee K, Lee G, Hawthorne D, Clifford R, Potter K, Etherton‐Beer C (2024) The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis. British Journal of Clinical Pharmacology 90(10): 2409–2482. https://doi.org/10.1111/bcp.16200 Rasheed MK, Hasan SS, Alqasoumi A, Babar ZU-D (2023) Impact of an educational program on community pharmacist’s preparedness to conduct pharmacist-led diabetes clinic in Saudi Arabia. Journal of Pharmaceutical Policy and Practice 16(1): 1–87. https://doi. org/10.1186/s40545-023-00597-2 Thompson W, McDonald EG (2024) Polypharmacy and deprescribing in older adults. Annual Review of Medicine 75(1): 113–127. https://doi. org/10.1146/annurev-med-070822-101947 van Poelgeest EP, Seppala LJ, Lee JM, Bahat G, Ilhan B, Lavan AH, Mair A, van Marum RJ, Onder G, Ryg J, Fernandes MA, Garfinkel D, Guðmundsson A, Hartikainen S, Kotsani M, Montero-Errasquín B, Neumann-Podczaska A, Pazan F, Petrovic M, Soulis G, Vankova H, Wehling M, Wieczorowska-Tobis K, van der Velde N (2022) Deprescribing practices, habits and attitudes of geriatricians and geriatricians-in-training across Europe: A large web-based survey. European Geriatric Medicine 13(6): 1455–1466. https://doi.org/10.1007/ s41999-022-00702-9 Wang Z, Liu T, Su Q, Luo H, Lou L, Zhao L, Kang X, Pan Y, Nie Y (2024) Prevalence of polypharmacy in elderly population worldwide: A systematic review and meta‐analysis. Pharmacoepidemiology and Drug Safety 33(8): e5880. https://doi.org/10.1002/pds.5880 Woodward MC (2003) Deprescribing: Achieving better health outcomes for older people through reducing medications. Journal of Pharmacy Practice and Research 33(4): 323–328. https://doi.org/10.1002/ jppr2003334323 Wu H, O’Donnell LK, Fujita K, Masnoon N, Hilmer SN (2021) Deprescribing in the older patient: A narrative review of challenges and solutions. International Journal of General Medicine 14: 3793–3807. https://doi.org/10.2147/IJGM.S253177