A narrative review of evidence to guide deprescribing among older adults

Abstract

Potentially inappropriate prescription and polypharmacy are well‐known risk factors for morbidity and mortality among older adults. However, recent systematic reviews have failed to demonstrate the overall survival benefits of deprescribing. Thus, it is necessary to synthesize the current evidence to provide a practical direction for future research and clinical practice. This review summarizes the existing body of evidence regarding deprescribing to identify useful intervention elements. There is evidence that even simple interventions, such as direct deprescribing targeted at risky medications and explicit criteria‐based approaches, effectively reduce inappropriate prescribing. On the other hand, if the goal is to improve clinical outcomes such as hospitalization and emergency department visits, patient‐centered multimodal interventions such as a combination of medication review, multidisciplinary collaboration, and patient education are likely to be more effective. We also consider the opportunities and challenges for deprescribing within the Japanese healthcare system.

Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan

“…Several existing studies have addressed the concept of polydoctoring, yet a clear definition has not been established. [10][11][12][13]26 Therefore, in this study, we define polydoctoring as a situation where multiple physicians are regularly involved in the care of chronic conditions in a single patient. To measure polydoctoring, we developed a new indicator named Regularly Visited Facilities (RVFs).…”

“…This phenomenon, known as polydoctoring, is akin to polypharmacy. [10][11][12][13] An increase in the number of involved healthcare providers does not directly translate to fragmented care. With appropriate care coordination, effective and efficient team-based care can be achieved, even when numerous healthcare providers are involved.…”

“…In Japan, where free access to care, including specialists, is guaranteed, it is common for patients to have a different primary physician for each condition. This phenomenon, known as polydoctoring, is akin to polypharmacy 10–13 . An increase in the number of involved healthcare providers does not directly translate to fragmented care.…”

Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review

“…However, medical records of different specialists, hospitals and primary care centres were usually not connected. The so-called polydoctoring (Ie et al, 2021) makes it difficult or even impedes access to a complete medical record of patients. This situation underlines the importance of the figure of the family doctor as a central element of health care, integrating the different past or current processes that affect their patients and reflecting it in reliable and up-to-date medical records.…”

Deprescribing as an Opportunity to Facilitate Patient-Centered Care: A Qualitative Study of General Practitioners and Pharmacists in Japan

“…The evidence on the effects of deprescribing on clinical outcomes among older adults remains controversial [ 6 , 7 , 8 ], potentially owing to the ambiguity of both polypharmacy patient populations and deprescribing interventions. However, it has been suggested that patient-centered multimodal deprescribing, compared to uniform deprescribing without elements of shared decision making (e.g., reducing a specific risky medication), may be more effective in improving clinical outcomes [ 9 ]. Therefore, it is essential to explore the shared decision-making process that leads to clinically effective deprescribing.…”