Deprescribing: Practical Ways to Support Person-Centred, Evidence-Based Deprescribing

Abstract

Deprescribing is complex and multifactorial with multiple approaches described in the literature. Internationally, there are guidelines and tools available to aid clinicians and patients to identify and safely withdraw inappropriate medications, post a shared decision-making medicines optimisation review. The increase in available treatments and use of single disease model guidelines have led to a healthcare system geared towards prescribing, with deprescribing often seen as a separate activity. Deprescribing should be seen as part of prescribing, and is a key element in ensuring patients remain on the most appropriate medications at the correct doses for them. Due to the complex nature of polypharmacy, every patient experience and relationship with medications is unique. The individual’s history must be incorporated into a patient-centred medication review, in order for medicines to remain optimal through changes in circumstance and health. Knowledge of the law and appropriate recording is important to ensure consent is adequately gained and recorded in line with processes followed when initiating a medication. In recent years, with the increase in interested clinicians globally, a number of prominent networks have grown, creating crucial links for both research and sharing of good practice.

A Collaborative Deprescribing Intervention in a Subacute Medical Outpatient Clinic: A Pilot Randomized Controlled Trial

“…The authors suggested that this low acceptance rate was related to miscommunication between the two healthcare sectors [ 33 ]. Studies have reported that involving patients in the describing process and keeping patients updated about their own medication status is just as crucial for implementation of deprescribing within different settings [ 34 , 35 ]. We believe that our high rate of sustained deprescribed medications is the result of utilizing motivational conversation together with following up with the patient seven days post inclusion by telephone.…”

Shared Decision Making with Acutely Hospitalized, Older Poly-Medicated Patients: A Mixed-Methods Study in an Emergency Department

“…In our findings, all patients would prefer to take less medicine, but the non-active patients did not reveal their preferences for less medicine until they were explicitly asked about it, which the healthcare professionals should be aware of. A study by Le Bosquet et al (2019) also found that some patients prefer not to become involved and highlights that it is the healthcare professionals’ responsibility to assess the amount of involvement the patients want [ 50 ].…”

Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis

“…These include a National Institute for Health and Care Excellence (NICE) guideline 11 focused specifically on the deprescribing of hypnotics and a number of institutional resources describing best practice aimed at supporting staff managing the problem in the field, [12][13][14] as well as expert commentaries from academics working in the field. 15,16 All seek to support professionals in the complex process of tailoring medication use to individual circumstances and in making 'defendable decisions' with regard to the individual tailoring of medicines. 6,17 Much of the guidance to date draws on the principles of good prescribing practice, supported by data on prescribing for specific conditions.…”