Deprescribing intervention activities mapped to guiding principles for use in general practice: a scoping review

Abstract

ObjectiveTo identify and characterise activities for deprescribing used in general practice and to map the identified activities to pioneering principles of deprescribing.SettingPrimary care.Data sourcesMedline, EMBASE (Ovid), CINAHL, Australian New Zealand Clinical Trials Registry (ANZCTR), Clinicaltrials.gov, ISRCTN registry, OpenGrey, Annals of Family Medicine, BMC Family Practice, Family Practice and British Journal of General Practice (BJGP) from inception to the end of June 2021.Study selectionIncluded studies were original research (randomised controlled trial, quasi-experimental, cohort study, qualitative and case studies), protocol papers and protocol registrations.Data extractionScreening and data extraction was completed by one reviewer; 10% of the studies were independently reviewed by a second reviewer. Coding of full-text articles in NVivo was conducted and mapped to five deprescribing principles.ResultsFifty studies were included. The most frequently used activities were identification of appropriate patients for deprescribing (76%), patient education (50%), general practitioners (GP) education (48%), and development and use of a tapering schedule (38%). Six activities did not align with the five deprescribing principles. As such, two principles (engage practice staff in education and appropriate identification of patients, and provide feedback to staff about deprescribing occurrences within the practice) were added.ConclusionActivities and guiding principles for deprescribing should be paired together to provide an accessible and comprehensive guide to deprescribing by GPs. The addition of two principles suggests that practice staff and practice management teams may play an instrumental role in sustaining deprescribing processes within clinical practice. Future research is required to determine the most of effective activities to use within each principle and by whom.

Prevalence and Severity of Potential Drug–Drug Interactions in Patients with Multiple Sclerosis with and without Polypharmacy

“…For example, if a patient is taking opioid analgesics, their doctor would know that possible constipation is not an independent symptom but a side effect of the established medication [ 44 ]. There are many more approaches to reduce the risk of PP and of possibly dangerous DDIs [ 59 , 60 ].…”

Withdrawal of antihypertensive medication in young to middle-aged adults: a prospective, single-group, intervention study

“…A similar finding was observed in previous studies [ 7 , 24 ]; Buranakitjaroen et al [ 24 ] found that about 10% of the patients who stopped their antihypertensive medications self-medicated by supplementing their antihypertensive medications due to anxiety or feeling unwell. Clinicians need to pay attention to patients' psychological status when deprescribing antihypertensive medication, which is one of the principles suggested by Coe et al [ 31 ]. One patient reported that the family’s concern about medication withdrawal was a primary reason to withdraw from the study.…”

General Practice Patients’ Experiences and Perceptions of the WiserAD Structured Web-Based Support Tool for Antidepressant Deprescribing: Protocol for a Mixed Methods Case Study With Realist Evaluation

“…The focus groups were analyzed thematically to identify barriers and facilitators to antidepressant deprescribing and inform the development of the first prototype of the WiserAD intervention. Second, a scoping review of 50 deprescribing interventions being used in general practice for any condition and medication was conducted in 2021 [44]. The scoping review identified key deprescribing activities and provided additional steps to create a self-sustaining deprescribing process loop for use in clinical practice.…”