Abstract
AimsThis review investigates the factors that influence deprescribing of medications in primary care from the perspective of general practitioners (GPs) and community‐living older adults.MethodsA mixed studies review structure was adopted searching Scopus, CINAHL, PsychINFO, ProQuest, and PubMed from January 2000 to December 2017. A manual search of reference lists was also conducted. Studies were included if they were original research available in English and explored general deprescribing rather than deprescribing of a specific class of medications. The Mixed Methods Assessment Tool was used to assess the quality of studies, and content analysis generated common categories across studies.ResultsThirty‐eight articles were included, and 7 key categories were identified. The review found that the factors that influence deprescribing are similar across and within health systems and mostly act as barriers. These factors remained unchanged across the review period. The structural organisation of health systems remains poorly suited to facilitate deprescribing. Individual knowledge gaps of both GPs and older adults influence practices and attitudes towards deprescribing, and significant communication gaps occur between GPs and specialists and between GPs and older adults. As a result, deprescribing decision making is characterised by uncertainty, and deprescribing is often considered only when medication problems have already arisen. Trust plays a complex role, acting as both a barrier and facilitator of deprescribing.ConclusionsDeprescribing is influenced by many factors. Despite recent interest, little change has occurred. Multilevel strategies aimed at reforming aspects of the health system and managing uncertainty at the practice and individual level, notably reducing knowledge limitations and closing communications gaps, may achieve change.
Highlights
This review investigates the factors that influence deprescribing of medications in primary care from the perspective of general practitioners (GPs) and community‐living older adults
Articles discussing deprescribing within long‐term residential aged care facilities were excluded, as the nature of such care changes the relationship between primary care providers and older adults, limiting the ability of older adults to act autonomously.[29]
As far as we are aware, this is the first mixed studies review to consider the factors that influence deprescribing for both community‐living older adults and GPs
Summary
Full text primary research articles were included that were available in English, published between January 2000 and December 2017, and that investigated deprescribing or medication cessation/discontinuation in the primary care context for older adults, living independently in the community. Articles were included where deprescribing was mentioned as a mechanism to reduce polypharmacy or potentially inappropriate medications or in the context of the management of multiple morbidities. Deprescribing of specific medications or medication classes were not included, as unique factors related to individual medication use, such as specific withdrawal issues, might have influenced deprescribing practices and attitudes in these instances. Articles were excluded if they only related to discontinuing medications during palliative stages of care, as the context of medication deprescribing is markedly different in these scenarios.[30]
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