Deprescribing guidelines falling short: study

More than two-thirds of clinical practice guidelines do not contain any recommendations on deprescribing, reveals a new study led by Monash Institute of Pharmaceutical Sciences’ Centre for Medicine Use and Safety (CMUS).

As the potential benefits and harms of medicines can change for each individual over time, medication reviews and deprescribing guidance should be considered an essential part of the prescribing process, suggest the researchers.

They identified guidelines from Europe, North America, Australia, Asia and Africa published in the last 10 years, but despite the vast range in demographics and healthcare systems, insufficient deprescribing recommendations were found to be a universal trend.

Only 29% of guidelines contained a deprescribing recommendation, the study found. Furthermore, of the 80 guidelines that included deprescribing recommendations, most did not have detailed information on how to deprescribe.

While medicines have many important benefits in curing and preventing diseases, along with improving symptoms, the findings of this review highlight a glaring omission in clinical practice guidelines internationally, said co-first author and CMUS Research Fellow Dr Aili Langford.

“While deprescribing recommendations are becoming more common, which is encouraging to see, what stood out is the need for greater clarity and specificity in these recommendations. If recommendations are unclear, they are unlikely to be implemented as intended.

“The potential benefits and harms of medicines can change over time as a person ages, acquires new medical conditions, takes new medicines and changes their care goals. Therefore, medicines should be regularly reviewed to make sure that they are still of benefit, and not causing harm.”

In Australia, around 400,000 people present to emergency departments each year because of medication-related problems, with at least 50% of this harm deemed preventable. The issue is further inflated for people living in aged care facilities, where more than 95% have at least one problem with their medicines detected at the time of a medicines review.

Co-first author Imaan Warriach, a research student from University College London who worked at CMUS while conducting the research, said at a societal level, deprescribing plays an important role in reducing low-value care and overtreatment, as well as avoiding preventable medicine-related harm.

“At the patient level, benefits of deprescribing may include improved adherence, reduced medicine-related costs and burden, and resolution of adverse drug reactions,” Warriach said.

“However, implementation of deprescribing in practice remains limited due to various patient, prescriber and organisation-level barriers. Specifically, limitations in healthcare professionals’ knowledge of when and how to safely and effectively deprescribe.”

Senior author and Chair of the Australian Deprescribing Network (ADeN), Dr Emily Reeve said the team are conducting ongoing research to help determine how they can best support the development of actionable and evidence-based deprescribing recommendations.

“While more comprehensive deprescribing recommendations may facilitate the implementation of deprescribing in practice, there remains a need for recommendations to be simple and digestible,” Reeve said.

“Guideline language, for example, is integral — recommendations should be uncomplicated, clear and persuasive.  Although clinician expertise and discretion can be used to bridge the gap between recommendations and practice, in the absence of clear deprescribing recommendations, there is concern that recommendations will be misapplied, leading to unintended harm.”

This CMUS study, published in the British Medical Journal (BMJ) Quality and Safety, contributes to ongoing efforts in Australia and internationally to enhance patient care by supporting healthcare professionals and patients to engage in deprescribing.

Image credit: iStock.com/PeopleImages