Review of deprescribing processes and development of an evidence‐based, patient‐centred deprescribing process

Abstract

Inappropriate use of medication is widespread, especially in older people, and is associated with risks, including adverse drug reactions, hospitalization and increased mortality. Optimization of appropriate medication use to minimize these harms is an ongoing challenge in healthcare. The term ‘deprescribing’ has been used to describe the complex process that is required for safe and effective cessation of medication. Patients play an important role in their own health and, while they may complain about the number of medications they have to take, they may also be reluctant to cease a medication when given the opportunity to do so. A review of previously proposed deprescribing processes and relevant literature was used to develop the patient‐centred deprescribing process, which is a five‐step cycle that encompasses gaining a comprehensive medication history, identifying potentially inappropriate medications, determining whether the potentially inappropriate medication can be ceased, planning the withdrawal regimen (e.g. tapering where necessary) and provision of monitoring, support and documentation. This is the first deprescribing process developed using knowledge of the patients' views of medication cessation; it focuses on engaging patients throughout the process, with the aim of improving long‐term health outcomes. Despite a comprehensive review of the literature, there is still a lack in the evidence base on which to conduct deprescribing. The next step in broadening the evidence to support deprescribing will be to test the developed process to determine feasibility in the clinical setting.

A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

“…Seventy-eight words occurred two or more times. The most common words were medication (47), deprescribing (42), patient (19), and process (15). The terms withdraw, cease, discontinue and stop (and grouped stemmed words) occurred a total of 55 times, with withdrawal the most common (14).…”

“…Use of this term also covers the characteristic of 'steps'. Various research supports that a process is required for safe and effective deprescribing [15]. The characteristic of medication cessation is at the core of deprescribing (regardless of the specific word used, however, withdrawal was the most favoured).…”

“…However, the high prevalence of polypharmacy and PIMs and lack of guidelines for people with multi-morbidity and polypharmacy support focusing on desprescribing as a separate entity in research and practice [13][14][15]. This will require a clear and consistent definition of deprescribing.…”

Swimming Against the Tide: Primary Care Physicians’ Views on Deprescribing in Everyday Practice

“…[8][9][10] Safe prescribing entails regular medicines review, initiating medicines that are indicated, and deprescribing (tapering and withdrawing medicines) when the risks outweigh the potential benefits. [11][12][13] While the term "deprescribing" is relatively new, the process of deprescribing has long been essential to best prescribing practice and is a task all primary care physicians are familiar with.…”

A concept analysis of deprescribing medications in older people

“…24 No specific definition exists for the word 'deprescribing', and the term is used inconsistently. [25][26][27] Two recent papers proposed definitions for deprescribing as a process to reduce medication use, although there is limited consensus on what does or does not constitute deprescribing. 9,26 The inconsistent definition and conceptualisation is increasingly problematic.…”