Barriers and facilitators to deprescribing in primary care: a systematic review

Doherty, Alison Jayne; Boland, Paul; Reed, Janet; Clegg, Andrew; Stephani, Anne-Marie; Williams, Nefyn; Shaw, Beth; Hedgecoe, Lynn; Hill, Ruaraidh; Walker, Lauren

doi:10.3399/bjgpopen20x101096

Cited by 103 publications

(112 citation statements)

References 72 publications

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“…22 Existing studies do not always explicitly specify concurrent medications and chronic conditions present, nor do they consistently account for these potential confounders, making it difficult to apply available evidence to multimorbid patients with polypharmacy seen in clinical practice. 26,29,30 Additionally, patient populations such as palliative care https://doi.org/10.2147/IJGM.S253177…”

Section: Deprescribing Research: Issues For Patients/consumersmentioning

confidence: 99%

“…20,30 Therefore, there is a need for future research to explore deprescribing different drug classes seen in practice, in different patient populations and explicitly specify characteristics of the study population such as medical conditions and concurrent medications, adjusting for any potential confounders. 20,22,25,29,30 Deprescribing Research: Issues for Current Healthcare Systems Deprescribing interventions can be time-consuming and resource-intensive in addition to the ongoing cost of using different medications. 28 Deprescribing harmful medications may however result in potential cost savings such as less visits to the general practitioner and reduced number of hospitalizations.…”

Section: Dovepressmentioning

confidence: 99%

“…22 Not specifying comorbidities and concurrent medications and not accounting for these potential confounders. 26,29,30 Excluding patient populations such as palliative care. 20,30 Deprescribing different drug classes seen in practice, in different patient populations and explicitly specifying characteristics such as frailty, comorbidities and concurrent medications, adjusting for any potential confounders.…”

Section: Data On Clinical Outcomesmentioning

confidence: 99%

“…20,30 Deprescribing different drug classes seen in practice, in different patient populations and explicitly specifying characteristics such as frailty, comorbidities and concurrent medications, adjusting for any potential confounders. 20,22,29,30,82…”

Section: Data On Clinical Outcomesmentioning

confidence: 99%

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Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice. Deprescribing is an established management strategy to minimize polypharmacy and potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on the success of deprescribing interventions in research and practice. Management strategies that target all levels of the healthcare system are required to overcome these challenges. Future studies may consider large multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on clinical outcomes.

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Section: Deprescribing Research: Issues For Patients/consumersmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

Section: Data On Clinical Outcomesmentioning

confidence: 99%

Section: Data On Clinical Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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“…Patients often felt they 'needed' these medications, making it difficult for care providers to propose deprescription. 11 Seniors involved in the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) trial that elected not to discontinue their long-term benzodiazepine use, indicated that their main reasons were due to discouragement by their physician or pharmacist (33%) and fear of withdrawal symptoms (25%). 12 Over the years, as more medications are prescribed due to a natural increase in morbidities and these regimens become routine, patients slowly move towards polypharmacy and become more resistant to stopping the medications that have worked for them in the past but may no longer be indicated.…”

Section: Methodsmentioning

confidence: 99%

Deprescribing for all: a narrative review identifying inappropriate polypharmacy for all ages in hospital settings

et al. 2021

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Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.Patient consent for publication Not required.Ethics approval Ethics approval was obtained from the Ethics Committee.Provenance and peer review Not commissioned; externally peer reviewed.Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults

Herrinton

Alavi

et al. 2023

JAMA Netw Open

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ImportanceOlder patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects.ObjectiveTo test the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy.Design, Setting, and ParticipantsThis randomized clinical trial allocated patients 76 years or older who used 10 or more prescription medications to a deprescribing intervention or to usual care (1:1 ratio) at an integrated health system with multiple preexisting deprescribing workflows. Data were collected from October 15, 2020, to July 29, 2022.InterventionPhysician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation.Main Outcomes and MeasuresPrimary end points were change in the number of medications and in the prevalence of geriatric syndrome (falls, cognition, urinary incontinence, and pain) from 181 to 365 days after allocation compared with before randomization. Secondary outcomes were use of medical services and adverse drug withdrawal effects.ResultsOf a random sample of 2860 patients selected for potential enrollment, 2470 (86.4%) remained eligible after physician authorization, with 1237 randomized to the intervention and 1233 to usual care. A total of 1062 intervention patients (85.9%) were reached and agreed to enroll. Demographic variables were balanced. The median age of the 2470 patients was 80 (range, 76-104) years, and 1273 (51.5%) were women. In terms of race and ethnicity, 185 patients (7.5%) were African American, 234 (9.5%) were Asian or Pacific Islander, 220 (8.9%) were Hispanic, 1574 (63.7%) were White (63.7%), and 257 (10.4%) were of other (including American Indian or Alaska Native, Native Hawaiian, or &gt;1 race or ethnicity) or unknown race or ethnicity. During follow-up, both the intervention and usual care groups had slight reductions in the number of medications dispensed (mean changes, −0.4 [95% CI, −0.6 to −0.2] and −0.4 [95% CI, −0.6 to −0.3], respectively), with no difference between the groups (P = .71). There were no significant changes in the prevalence of a geriatric condition in the usual care and intervention groups at the end of follow-up and no difference between the groups (baseline prevalence: 47.7% [95% CI, 44.9%-50.5%] vs 42.9% [95% CI, 40.1%-45.7%], respectively; difference-in-differences, 1.0 [95% CI, −3.5 to 5.6]; P = .65). No differences in use of medical services or adverse drug withdrawal effects were observed.Conclusions and RelevanceIn this randomized clinical trial from an integrated care setting with various preexisting deprescribing workflows, a bundled hyperpolypharmacy deprescribing intervention was not associated with reduction in medication dispensing, prevalence of geriatric syndrome, utilization of medical services, or adverse drug withdrawal effects. Additional research is needed in less integrated settings and in more targeted populations.Trial RegistrationClinicalTrials.gov Identifier: NCT05616689

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Barriers and facilitators to deprescribing in primary care: a systematic review

Cited by 103 publications

References 72 publications

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Deprescribing for all: a narrative review identifying inappropriate polypharmacy for all ages in hospital settings

Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults

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