Evidence map›Paper›PMID 32723784›Full record

ArticleBJGP open2020

Barriers and facilitators to deprescribing in primary care: a systematic review.

Alison Jayne Doherty, Paul Boland, Janet Reed, Andrew J Clegg, Anne-Marie Stephani, Nefyn Howard Williams, Beth Shaw, Lynn Hedgecoe, Ruaraidh Hill, Lauren Walker

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BJGP open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 131 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
131citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

131 citing papers in PubMed, 11 syntheses or guidelines pooled it.

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  3. Screening for potentially inappropriate prescribing in primary care: Canadian guideline.Canadian family physician Medecin de famille canadien · 2026
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71 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Alison Jayne DohertyFaculty of Health & Wellbeing, University of Central Lancashire, Preston, UK adoherty7@uclan.ac.uk.ORCID http://orcid.org/0000-0003-3593-8069
Paul BolandFaculty of Health & Wellbeing, University of Central Lancashire, Preston, UK.
Janet ReedFaculty of Health & Wellbeing, University of Central Lancashire, Preston, UK.
Andrew J CleggFaculty of Health & Wellbeing, University of Central Lancashire, Preston, UK.
Anne-Marie StephaniUniversity of Central Lancashire, Preston, UK.
Nefyn Howard WilliamsHealth Services Research, University of Liverpool, Liverpool, UK.ORCID http://orcid.org/0000-0002-8078-409X
Beth ShawOregon Health & Science University, Portland, Oregon, US.
Lynn HedgecoeUniversity of Liverpool, Liverpool, UK.
Ruaraidh HillHealth Services Research, University of Liverpool, Liverpool, UK.
Lauren WalkerUniversity of Liverpool, Liverpool, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundManaging polypharmacy is a challenge for healthcare systems globally. It is also a health inequality concern as it can expose some of the most vulnerable in society to unnecessary medications and adverse drug-related events. Care for most patients with multimorbidity and polypharmacy occurs in primary care. Safe deprescribing interventions can reduce exposure to inappropriate polypharmacy. However, these are not fully accepted or routinely implemented.

aimTo identify barriers and facilitators to safe deprescribing interventions for adults with multimorbidity and polypharmacy in primary care. DESIGN &

settingA systematic review of studies published from 2000, examining safe deprescribing interventions for adults with multimorbidity and polypharmacy.

methodA search of electronic databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature (CINHAL), Cochrane, and Health Management Information Consortium (HMIC) from inception to 26 Feb 2019, using an agreed search strategy. This was supplemented by handsearching of relevant journals, and screening of reference lists and citations of included studies.

resultsIn total, 40 studies from 14 countries were identified. Cultural and organisational barriers included: a culture of diagnosing and prescribing; evidence-based guidance focused on single diseases; a lack of evidence-based guidance for the care of older people with multimorbidities; and a lack of shared communication, decision-making systems, tools, and resources. Interpersonal and individual-level barriers included: professional etiquette; fragmented care; prescribers' and patients' uncertainties; and gaps in tailored support. Facilitators included: prudent prescribing; greater availability and acceptability of non-pharmacological alternatives; resources; improved communication, collaboration, knowledge, and understanding; patient-centred care; and shared decision-making.

conclusionA whole systems, patient-centred approach to safe deprescribing interventions is required, involving key decision-makers, healthcare professionals, patients, and carers.

Indexed as

deprescribinggeneral practicemultimorbiditypolypharmacyprimary careprimary health carereview

Identifiers

PMID32723784
PMCPMC7465575

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.