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

Abstract

Aims The aim of this study was to identify what definitions have been published for the term ‘deprescribing’, and determine whether a unifying definition could be reached. A secondary aim was to uncover patterns between the published definitions which could explain any variation. Methods Systematic literature searches were performed (earliest records to February 2014) in MEDLINE, Embase, CINAHL, Informit, Scopus and Google Scholar. The terms deprescrib* or de‐prescrib* were employed as a keyword search in all fields. Conventional content analysis and word frequencies were used to identify characteristics of the definitions. Network analysis was conducted to visualize characteristic distribution across authors and articles. Results Following removal of duplicates, 231 articles were retrieved, 37 of which included a definition. Eight characteristics of the definitions were identified: use of the term stop/withdraw/cease/discontinue (35 articles), aspect of prescribing included e.g. long term therapy/inappropriate medications (n = 18), use of the term ‘process’ or ‘structured’ (n = 13), withdrawal is planned/supervised/judicious (n = 11), involving multiple steps (n = 7), includes dose reduction/substitution (n = 7), desired goals/outcomes described (n = 5) and involves tapering (n = 4). Network analysis did not reveal patterns responsible for variations in previously used definitions. Conclusions These findings show that there is lack of consensus on the definition of deprescribing. This article proposes the following definition: ‘Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’. This definition has not yet been externally validated and further work is required to develop an internationally accepted and appropriate definition.

Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care

“…Deprescribing has been suggested as a potential method to reduce inappropriate polypharmacy in residential aged care settings. Deprescribing involves a completion of a review of an individual's current medications and subsequent withdrawal of inappropriate medications with supervision from a healthcare professional after careful consideration of the likelihood of adverse events with a goal of improving clinical outcomes [26,27]. Interventions for deprescribing have been trialled in residential aged care facilities, however the effects of these interventions as shown in randomised controlled trials (RCTs) have been mixed and further studies are required [28][29][30][31][32][33]26].…”

Deprescribing: a new goal focused on the patient

“…It is estimated that one-fifth of adult patients are treated with polypharmacy (five or more drugs) and the prevalence of this phenomenon in the elderly is higher, ranging from 30% to 70%, even reaching 90% in residents of residential aged care facilities [1][2][3][4]. Polypharmacy in the elderly increases the risk of adverse reactions, inappropriate prescriptions, drug interactions, number of hospitalizations, costs, and even death [5].…”

“…Since 2003 the term 'deprescribing' was introduced into the scientific literature in English, seeking to improve outcomes associated with polypharmacy and potentially inappropriate medications in the elderly [2,6], but only in recent years has the term gained strength and diffusion, despite the lack of a formally accepted definition [2]. In a recent systematic review, the authors proposed defining deprescribing as 'the process of withdrawal of inappropriate medication supervised by a health care professional with the goal of managing polypharmacy and improving outcomes' [2], while Scott et al define it as 'the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing benefits within the context of an individual patient's care goals, current level of functioning, life expectancy, values and preferences' [3].…”

Education and Assessment of Pharmacists on the Use of the Drug Burden Index in Older Adults Using a Continuing Professional Development Education Method

“…26 The intervention included topics surrounding the principles, evidence for, and application of the DBI in older adults, and related topics such as polypharmacy and deprescribing (the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes), and was defined in the education article in the context of implementing DBI in practice. [27][28][29] The article included a fictional case study designed to elicit discussion of actions and recommendations following a HMR and to assess the calculation of DBI, to address barriers, facilitators, and implementation.…”