Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.

The prevalence of breast cancer in Sri Lanka is on the rise. A need analysis was carried out to identify the learning needs and utilization of currently available learning resources on breast cancer management among the general practitioners (GPs) in Sri Lanka. A pretested questionnaire was posted to 210 GPs affiliated to College of General Practitioners of Sri Lanka. The data were analyzed using descriptive statistics. Response rate was 55.2%. Fifty nine (50.9%) participants were aged between 31-50 years and 77 (66.4%) were males. Majority 87(75%) had not previously taken part in any CPD program on breast cancer management. Awareness on the guide for primary care doctors and family physicians on management of breast symptoms (31, 26.7%) and national guidelines on management of breast carcinoma (20, 17.2%) were markedly low. Although majority (99, 85.3%) reported a medium to high involvement in referral, 77(66.4%) admitted of low involvement in shared follow up care while 72(62.1%) reported low involvement in palliative care. Accordingly, palliative care (68,58.6%) and shared follow up care(77,66.4%) were identified to be among the top two priority areas to be included in a future CPD module. Majority (83, 71.5%) preferred either online or blended modes of learning. In conclusion, participation of GPs in CPD programs on breast cancer management and awareness on current guidelines are deficient. Although current involvement in referral of breast cancer patients for tertiary care is substantial, involvement in shared follow up care and palliative care is low. Thus, a future online CPD module should be established with greater emphasize on these areas.