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

Objective To identify and characterise activities for deprescribing used in general practice and to map the identified activities to pioneering principles of deprescribing. Setting Primary care. Data sources Medline, 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 selection Included studies were original research (randomised controlled trial, quasi-experimental, cohort study, qualitative and case studies), protocol papers and protocol registrations. Data extraction Screening 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. Results Fifty 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. Conclusion Activities 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.

Automated summary

The study aimed to identify and characterize activities for deprescribing in general practice and map them to deprescribing principles. The most frequently used activities included identifying appropriate patients for deprescribing, patient and GP education, and tapering schedule development. The addition of two principles suggests the importance of practice staff and management teams in sustaining deprescribing processes. Future research is needed to determine effective activities for each principle and their implementation.