Background Based on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. Methods This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. Results Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. Conclusions It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.

This dissertation, which includes three essays, examines different dimensions of the adoption of SPIS. It intends to contribute to filling this literature gap, which is relevant to the specific policy and enriches the literature on sustainability transitions in agriculture. / Indien fördert solarbetriebene Bewässerungssysteme (SPIS), um erneuerbare Energien in der Landwirtschaft zu stärken und die Subventionslast für Strom zu reduzieren. Trotz politischer Anreize bleibt die Akzeptanz gering. Eine Studie mit drei Aufsätzen untersucht die Einführung von SPIS und schließt bestehende Forschungslücken. Perspektiven der Stakeholder: Die Q-Methode zeigt zwei Haupthindernisse: wirtschaftlich-finanzielle und institutionelle Herausforderungen. 22 Befragte sortierten 20 Aussagen, die Faktorenanalyse betont die Notwendigkeit einer Neugestaltung der Politik und bessere Koordination der Behörden. Sozialpsychologische Faktoren: Der Reasoned Action Approach analysiert die Einführung bei 500 Landwirten in Karnataka. Einstellung, soziale Normen und wahrgenommene Verhaltenskontrolle beeinflussen die Adoptionsabsicht positiv. Technophobie hat einen negativen Einfluss. Tagesstromverfügbarkeit verbessert die Einstellung, während hohe Kosten und Reparaturprobleme sie verschlechtern. Informationskampagnen und Schulungsprogramme sind erforderlich. Politische Rahmenbedingungen: Ein Discrete Choice Experiment zeigt, dass Landwirte eine zehnjährige Kreditlaufzeit und garantierte Serviceleistungen bevorzugen. Finanzielle Anreize und gesicherte Reparaturdienste fördern die Akzeptanz. Insgesamt verdeutlicht die Studie zentrale Hürden und Politiklücken. Sie bietet konkrete Empfehlungen zur Förderung der SPIS-Einführung in Indien, darunter eine übergreifende Strategie, Informationskampagnen und langfristige Kredite. / India is promoting solar-powered irrigation systems (SPIS) to boost renewable energy use and reduce electricity subsidies in agriculture. Despite policy incentives, adoption remains low. Research has focused on financial viability, but understanding farmers' attitudes, perceptions, and preferences is crucial. Institutional support and stakeholder cooperation also play key roles. This study, comprising three essays, examines SPIS adoption to address these gaps. The first essay uses Q methodology to analyze stakeholder perspectives on adoption barriers. A Q sample of 20 statements was sorted by 22 respondents. Two key barriers were identified: (1) economic and financial constraints and (2) institutional and governance challenges. The findings highlight the need to reframe policies and enhance agency coordination. The second essay applies the reasoned action approach (RAA) to study socio-psychological factors affecting adoption. A survey of 500 farmers in Karnataka was analyzed using suitable models. Attitude, social norms, and perceived behavioral control significantly influenced adoption intentions, while technophobia negatively impacted them. The study underscores the need for targeted information campaigns and training programs. The third essay employs choice experiments to assess policy attributes affecting SPIS adoption. Data from 500 farmers was analyzed using suitable econometric techinques. Farmers showed strong preferences for a 10-year loan repayment period and guaranteed service provision. Addressing liquidity constraints and ensuring long-term repair services can enhance adoption. Overall, the study highlights key adoption barriers and policy gaps. The first essay calls for policy reframing and better interdepartmental coordination. The second emphasizes socio-psychological influences and the absence of information campaigns. The third suggests integrating long-term credit and service guarantees to complement subsidies.

Background Based on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. Methods This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. Results Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. Conclusions It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.