Patient Barriers to and Enablers of Deprescribing: a Systematic Review
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Inappropriate medication use is common in the elderly and the risks associated with their use are well known. The term deprescribing has been utilised to describe the complex process that is required for the safe and effective cessation of inappropriate medications. Given the primacy of the consumer in health care, their views must be central in the development of any deprescribing process.
The aim of this study was to identify barriers and enablers that may influence a patient’s decision to cease a medication.
A systematic search of MEDLINE, International Pharmaceutical Abstracts, EMBASE, CINAHL, Informit and Scopus was conducted and augmented with a manual search. Numerous search terms relating to withdrawal of medications and consumers’ beliefs were utilised.
Study eligibility criteria
Articles were included if the barriers or enablers were directly patient/carer reported and related to long-term medication(s) that they were currently taking or had recently ceased.
Study appraisal and synthesis methods
Determination of relevance and data extraction was performed independently by two reviewers. Content analysis with coding was utilised for synthesis of results.
Twenty-one articles met the criteria and were included in the review. Three themes, disagreement/agreement with ‘appropriateness’ of cessation, absence/presence of a ‘process’ for cessation, and negative/positive ‘influences’ to cease medication, were identified as both potential barriers and enablers, with ‘fear’ of cessation and ‘dislike’ of medications as a fourth barrier and enabler, respectively. The most common barrier/enabler identified was ‘appropriateness’ of cessation, with 15 studies identifying this as a barrier and 18 as an enabler.
Conclusions and implications of key findings
The decision to stop a medication by an individual is influenced by multiple competing barriers and enablers. Knowledge of these will aid in the development of a deprescribing process, particularly in approaching the topic of cessation with the patient and what process should be utilised. However, further research is required to determine if the proposed patient-centred deprescribing process will result in improved patient outcomes.
KeywordsHormone Replacement Therapy Primary Care Physician Medication Class Inappropriate Medication Narrative Synthesis
Emily Reeve is a recipient of an Australian Postgraduate Award PhD scholarship of which this research was conducted within. She has also received speaker honorarium for an Australian Association of Consultant Pharmacy workshop. Emily Reeve and Josephine To received a Society of Hospital Pharmacists Association/Celegene Information Technology in Hospital Pharmacy Grant (for a non-related project conducted at a similar time to this study). Ivanka Hendrix, Sepehr Shakib, Michael S. Roberts and Michael D. Wiese have no conflicts of interest that are directly relevant to this study.
- 2.Elliott R. Problems with medication use in the elderly: an Australian perspective. J Pharm Pract Res. 2006;36:58–66.Google Scholar
- 11.Woodward M. Deprescribing: achieving better health outcomes for older people through reducing medications. J Pharm Pract Res. 2003;33:323–8.Google Scholar
- 12.Le Couteur DG, Banks E, Gnjidic D, McLachlan A. Deprescribing. Aust Prescr. 2011;34:182–5.Google Scholar
- 17.Ostini R, Hegney D, Jackson C, Tett SE. Knowing how to stop: ceasing prescribing when the medicine is no longer required. J Manage Care Pharm. 2012;18:68.Google Scholar
- 20.Reeve E, Wiese MD, Hendrix I, Roberts M, Shakib S. Patient attitudes, beliefs and experiences of polypharmacy and willingness of deprescribing. J Am Geriatr Soc. 2013 (accepted).Google Scholar
- 26.TRIP. Trip database. 2012. http://www.tripdatabase.com (Accessed 1 July 2013).
- 27.The Joanna Briggs Institute. Systematic review registered trials. University of Adelaide. 2013. http://www.joannabriggs.edu.au (Accessed 1 July 2013).
- 29.Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M et al. Guidance on the conduct of narrative synthesis in systematic reviews. Lancaster: Institute of Health Research, ESRC Methods Programme; 2006.Google Scholar
- 65.Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. 2005;165:2618.PubMedCrossRefGoogle Scholar
- 70.Hardy JE, Hilmer SN. Deprescribing in the last year of life. J Pharm Pract Res. 2011.Google Scholar