Abstract
Proton pump inhibitors (PPIs) are widely prescribed in primary care but often continued longer than clinically necessary, exposing patients to avoidable risks. Digital decision-support tools have been proposed to assist clinicians in identifying and managing potentially inappropriate medications. The arriba-PPI tool was developed to facilitate conversations on PPI deprescribing between general practitioners (GPs) and patients, supporting evidence-based and shared decision-making. To explore GPs' experiences with the arriba-PPI tool in clinical practice and understand factors influencing its use and impact on PPI prescribing and discontinuation. A qualitative exploratory study embedded within a multicentre cluster-randomised controlled trial conducted in German general practices. Semi-structured interviews were conducted with 26 GPs from the intervention arm who had used the tool. Interviews were analysed following Braun and Clarke's six-step thematic analysis methodology, applying a combined deductive-inductive approach. Six main themes emerged: perceived usefulness and acceptance of the tool; tool functionality and areas for improvement; patient perspectives and characteristics; doctor-patient interaction and consultation dynamics; PPI prescribing and discontinuation practices; and implementation context and long-term use. GPs valued the tool's structured format and visual aids for enhancing communication, particularly with patients reluctant to stop PPIs. Some described an educational benefit, reporting greater awareness and reflection on their own prescribing behaviour. Barriers to sustained use included technical issues, workflow integration challenges, and the absence of non-pharmacological alternatives. Trust and established doctor-patient relationships were seen as critical for successful deprescribing, often surpassing the tool's direct influence. While the arriba-PPI tool supports deprescribing conversations, its effectiveness depends on seamless integration, technical optimisation, and complementary non-drug strategies. Future digital interventions should follow established frameworks for complex intervention development, adopt a more holistic approach, and combine technological support with broader patient-centred care to achieve sustained deprescribing success in primary care.