How can deprescribing be safely and routinely implemented within primary care?

Background: As a result of ageing and advances in technology, people are living longer with multiple co-morbidities, and are likely to take multiple medicines concurrently. This can lead to problematic polypharmacy and the use of inappropriate medicines, compromised patient safety, and higher costs. Deprescribing has been identified as a way of addressing problematic polypharmacy. However, there is limited knowledge, derived from implementation science, concerning the safe and routine implementation of deprescribing in primary care.

Aim: To identify the barriers and facilitators, and effective strategies, to safe and routine implementation of deprescribing in primary care.

Methods: A multi-method, pragmatic approach used Normalisation Process Theory to guide research methods and contextualise findings. This comprised a systematic review to identify barriers and facilitators to deprescribing implementation and interviews with patients and healthcare professionals to explore their views on deprescribing in primary care. This informed a co-design process with patients and healthcare professionals to produce deprescribing resources to aid implementation in primary care.

Results: A lack of reporting of implementation factors and research on deprescribing appraisal was identified. Patients highlighted the significance of deprescribing rationales; clear communication; interpersonal skills; education; support; and provided views on healthcare professionals’ involvement. Healthcare professionals expressed that current healthcare is focused on prescribing with minimal deprescribing consideration, how stakeholder buy-in can drive implementation, how safety can be maintained through follow-ups and safety nets, and the potential role of community pharmacists. The co-design process identified patients as potential catalysts for routine deprescribing, and the role of community pharmacists as a safety net. This led to the development of medicine necessity questions for patients and a logic model of a community pharmacy deprescribing safety net.

Conclusion: Deprescribing resources have been developed that may aid the implementation of routine, safe deprescribing in primary care. Future work should assess their feasibility and effectiveness.